Provider Demographics
NPI:1649702762
Name:PREMIER WOMEN'S CARE PLLC
Entity type:Organization
Organization Name:PREMIER WOMEN'S CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:JOHNSON-LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-964-6829
Mailing Address - Street 1:2135 VALLEYGATE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3751
Mailing Address - Country:US
Mailing Address - Phone:910-964-6829
Mailing Address - Fax:910-339-9040
Practice Address - Street 1:2135 VALLEYGATE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3750
Practice Address - Country:US
Practice Address - Phone:910-964-6829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400406207V00000X
NC207V00000X
207V00000X
NC200400525207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty