Provider Demographics
NPI:1578295291
Name:LOCKHART, DEMETRIUS A
Entity Type:Individual
Prefix:
First Name:DEMETRIUS
Middle Name:A
Last Name:LOCKHART
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 1:5624 LANDMARK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-6970
Mailing Address - Country:US
Mailing Address - Phone:216-577-4753
Mailing Address - Fax:
Practice Address - Street 1:5624 LANDMARK DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-6970
Practice Address - Country:US
Practice Address - Phone:216-577-4753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)