Provider Demographics
NPI:1245617372
Name:HUNT, ALESE (MD)
Entity Type:Individual
Prefix:
First Name:ALESE
Middle Name:
Last Name:HUNT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALESE
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3602
Mailing Address - Country:US
Mailing Address - Phone:910-258-5774
Mailing Address - Fax:
Practice Address - Street 1:400 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358
Practice Address - Country:US
Practice Address - Phone:910-739-3318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC210682390200000X
NC2018-00447208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty