Organization
SOUTHEASTERN DERMATOLOGY, PA
Active
Organization
SOUTHEASTERN DERMATOLOGY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREW ADAM HENDRICKS MD (MEDICAL DIRECTOR)
(910) 738-7154
Entity
Organization
Contact information
Practice address
4390 FAYETTEVILLE RD, LUMBERTON, NC 28358-2677
(910) 738-7154
(910) 738-4455
Mailing address
4390 FAYETTEVILLE RD, LUMBERTON, NC 28358-2677
(910) 738-7154
(910) 738-4455
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8941520
—
NC
Enumeration date
06/17/2006
Last updated
10/31/2024
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