Organization
SOUTHEASTERN REGIONAL PHYSICIAN SERVICES
Active
Other names
Pain Management Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES T. JOHNSON III (CFO)
(910) 671-5090
Entity
Organization
Contact information
Practice address
4308 LUDGATE ST, LUMBERTON, NC 28358-2461
(910) 671-9298
(910) 738-3764
Mailing address
2600 N ELM ST, LUMBERTON, NC 28358-3011
(910) 272-3051
(910) 738-3764
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
H0064
NC
Other
Enumeration date
06/17/2009
Last updated
06/18/2009
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