Organization
SOUTHEASTERN REGIONAL PHYSICIAN SERVICES
Active
Other names
Fairmont Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES T. JOHNSON (CFO)
(910) 671-5090
Entity
Organization
Contact information
Practice address
101 N WALNUT ST, FAIRMONT, NC 28340-1951
(910) 628-0655
(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
261QR1300X
Rural Health Clinic/Center
Primary
H0064
NC
Other
Enumeration date
06/17/2009
Last updated
06/17/2009
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