SOUTHEASTERN DERMATOLOGY, PA
NPI 1922043629
Dermatology in Lumberton, NC

Active since June 17, 2006CLIA 34D0245307 · Certificate of Compliance
4390 FAYETTEVILLE RD, LUMBERTON, NC 28358(910) 738-7154(910) 738-4455 Get Directions Write a Review

NPPES record last updated: October 31, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Southeastern Dermatology, Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHEASTERN DERMATOLOGY, PA (NPI 1922043629) is a healthcare organization registered as a dermatology in Lumberton, North Carolina and active in the NPI registry since June 2006. The organization holds a CLIA Certificate of Compliance certificate valid through August 24, 2027 and lists Andrew Adam Hendricks, Medical Director, as its authorized official.

NPPES Registry Identity

NPI1922043629
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameSOUTHEASTERN DERMATOLOGY, PA
Location Address4390 FAYETTEVILLE RDLumberton, NC 28358-2677
Mailing Address4390 Fayetteville RdLumberton, NC 28358-2677 · (910) 738-7154 · Fax (910) 738-4455
Fax(910) 738-4455
Organization SubpartNo
Authorized OfficialAndrew Adam HendricksMedical Director · (910) 738-7154
Enumeration DateJune 17, 2006
Last NPPES UpdateOctober 31, 2024
NPPES CertifiedOctober 31, 2024
NPI 1922043629 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
4390 FAYETTEVILLE RD, Lumberton, NC 28358

Other Identifiers 1

Medicaid8941520NC

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 34D0245307

Southeastern Dermatology, PA · Lumberton, NC
Active · expires Aug 24, 2027
CLIA Number34D0245307
Laboratory TypePhysician Office
Certificate Effective DateAugust 25, 2025
Certificate Expiration DateAugust 24, 2027
Laboratory DirectorAndrew Hendricks
Laboratory Phone(910) 738-7154
Laboratory LocationSoutheastern Dermatology, PA4390 Fayetteville Rd, Lumberton, NC 28358
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Family Medicine
4390 FAYETTEVILLE RD
LUMBERTON, NC 28358
Physician Assistant
4390 FAYETTEVILLE RD
LUMBERTON, NC 28358
Dermatology
4390 FAYETTEVILLE RD
LUMBERTON, NC 28358

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southeastern Dermatology, PA's NPI number?

The NPI number for Southeastern Dermatology, PA is 1922043629. It was assigned to this organization in the NPPES registry on June 17, 2006.

Where is Southeastern Dermatology, PA located?

Southeastern Dermatology, PA is located at 4390 Fayetteville Rd, Lumberton, NC 28358. The listed phone number is (910) 738-7154.

What is Southeastern Dermatology, PA's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Does Southeastern Dermatology, PA hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 34D0245307) is associated with this NPI, valid through August 24, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Southeastern Dermatology, PA accept?

Health plans from Ambetter from Absolute Total Care, Ambetter of North Carolina and Blue Cross and Blue Shield of NC list Southeastern Dermatology, PA as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Southeastern Dermatology, PA was last updated on October 31, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.