Provider Demographics
NPI:1801185228
Name:HUNTER, CEDRIC LAWON (MD)
Entity Type:Individual
Prefix:
First Name:CEDRIC
Middle Name:LAWON
Last Name:HUNTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 CRESTHAVEN RD STE 500
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0846
Mailing Address - Country:US
Mailing Address - Phone:901-866-8525
Mailing Address - Fax:
Practice Address - Street 1:2304 WESVILL CT STE 360
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-2981
Practice Address - Country:US
Practice Address - Phone:919-785-1220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.071419208200000X
TN57634208200000X
CAA1227672086S0122X
NC2021-01783208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ038591Medicaid