Basic Information
| Provider Information | |||||||||
| NPI: | 1619139029 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROOKS-LOCKLEAR | ||||||||
| FirstName: | CHAMAINE | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1847 | ||||||||
| Address2: | |||||||||
| City: | LAURINBURG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283531847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | 9102760571 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 LAUCHWOOD DR | ||||||||
| Address2: | |||||||||
| City: | LAURINBURG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283525501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102916904 | ||||||||
| FaxNumber: | 9102916907 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2008 | ||||||||
| LastUpdateDate: | 02/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 30965 | SC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2011-00731 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | NC1479 | 05 | SC | MEDICAID | 5918442 | 05 | NC | MEDICAID |