Organization
SOUTHEASTERN REGIONAL MEDICAL CENTER
Active
Other names
Southeastern Radiology Associates
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES T. JOHNSON III (DIRECTOR)
(910) 671-5090
Entity
Organization
Contact information
Practice address
209 W 27TH ST, LUMBERTON, NC 28358-3016
(910) 738-8222
(910) 671-0846
Mailing address
300 W 27TH ST, LUMBERTON, NC 28358-3075
(910) 738-8222
(910) 671-8512
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H0064
STATE LICENSE
NC
Enumeration date
10/03/2012
Last updated
08/02/2016
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