Provider Demographics
NPI:1356652879
Name:STEPHENS, MELVIN J
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:J
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105B ELIZABETHTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3107
Mailing Address - Country:US
Mailing Address - Phone:910-738-7865
Mailing Address - Fax:
Practice Address - Street 1:2105B ELIZABETHTOWN ROAD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3107
Practice Address - Country:US
Practice Address - Phone:910-738-7865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24605173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine