Organization
BRADFORD K FAULKENBERRY M D P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA T WHEELER (PRACTICE MANAGER)
(910) 276-2439
Entity
Organization
Contact information
Practice address
1707 BERWICK DR, LAURINBURG, NC 28352-5543
(910) 276-2439
(910) 276-2404
Mailing address
1707 BERWICK DR, LAURINBURG, NC 28352-5543
(910) 276-2439
(910) 276-2404
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
78796
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0112P
BLUE CROSS BLUE SHIELD
—
05
—
790112P
—
NC
Enumeration date
03/02/2007
Last updated
03/09/2015
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