# BRADFORD K FAULKENBERRY M D P A

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053449777
- **Authorized official:** MRS. LISA T WHEELER (PRACTICE MANAGER)
- **Authorized official phone:** (910) 276-2439

## Contact information

- **Practice address:** 1707 BERWICK DR, LAURINBURG, NC 28352-5543
- **Practice address phone:** (910) 276-2439
- **Practice address fax:** (910) 276-2404
- **Mailing address:** 1707 BERWICK DR, LAURINBURG, NC 28352-5543
- **Mailing address phone:** (910) 276-2439
- **Mailing address fax:** (910) 276-2404

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 78796 | NC | Yes |

## Other

- **Enumeration date:** 03/02/2007
- **Last updated:** 03/09/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0112P | BLUE CROSS BLUE SHIELD | — |
| 05 | — | 790112P | — | NC |