Organization
CASES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BENNARD EVANS (ADMINISTRATOR)
(910) 272-0161
Entity
Organization
Contact information
Practice address
401 E 11TH ST, LUMBERTON, NC 28358-4807
(910) 272-0161
(910) 424-8300
Mailing address
401 E 11TH ST, LUMBERTON, NC 28358-4807
(910) 272-0161
(910) 424-8300
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5903134
—
NC
05
—
5903330
—
NC
Enumeration date
03/27/2007
Last updated
07/21/2022
Update your record
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