Provider Demographics
NPI:1548245160
Name:DABNEY, LISA G (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:G
Last Name:DABNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 MEDICAL PARK CT
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4346
Mailing Address - Country:US
Mailing Address - Phone:252-247-2013
Mailing Address - Fax:252-247-7299
Practice Address - Street 1:1165 CEDAR POINT BLVD STE H
Practice Address - Street 2:
Practice Address - City:CEDAR POINT
Practice Address - State:NC
Practice Address - Zip Code:28584-1030
Practice Address - Country:US
Practice Address - Phone:252-499-6850
Practice Address - Fax:252-393-1019
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9601585207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911294Medicaid
080140359OtherRAILROAD MEDICARE
NC8911294Medicaid
2236823CMedicare ID - Type Unspecified