Provider Demographics
NPI:1194844498
Name:STEDMAN FAMILY CLINIC, PLLC
Entity Type:Organization
Organization Name:STEDMAN FAMILY CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROOKS-HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-483-7776
Mailing Address - Street 1:7513 CLINTON RD.
Mailing Address - Street 2:
Mailing Address - City:STEDMAN
Mailing Address - State:NC
Mailing Address - Zip Code:28391
Mailing Address - Country:US
Mailing Address - Phone:910-483-7776
Mailing Address - Fax:910-483-1373
Practice Address - Street 1:7513 CLINTON RD.
Practice Address - Street 2:
Practice Address - City:STEDMAN
Practice Address - State:NC
Practice Address - Zip Code:28391-0358
Practice Address - Country:US
Practice Address - Phone:910-483-7776
Practice Address - Fax:910-483-1373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103685363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2279700BMedicare ID - Type UnspecifiedDR. BROOKS-FERNANDEZ #