Organization
SOUTHEASTERN REGIONAL MEDICAL CENTER
Active
Other names
Gibson CC
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES THOMAS JOHNSON (CHIEF REIMBURSMENT OFFICER)
(910) 671-5083
Entity
Organization
Contact information
Practice address
1200 PINE RUN DR, LUMBERTON, NC 28358-2180
(910) 737-6418
(910) 671-5732
Mailing address
300 W 27TH ST, LUMBERTON, NC 28358-3075
(910) 671-5290
(910) 671-8515
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
2086X0206X
Surgical Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912337684
—
NC
Enumeration date
11/18/2013
Last updated
09/08/2022
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