Basic Information
| Provider Information | |||||||||
| NPI: | 1912097288 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAMB | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | LAWRENCE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1173 ANGOLA BAY RD | ||||||||
| Address2: | |||||||||
| City: | WALLACE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284667135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102960941 | ||||||||
| FaxNumber: | 9102962771 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 N MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | KENANSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102960941 | ||||||||
| FaxNumber: | 9102962771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2006 | ||||||||
| LastUpdateDate: | 04/25/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 103678 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.