Provider Demographics
NPI:1538152525
Name:GUILLORY JOHNSON, LORIN ELAINE (MD)
Entity type:Individual
Prefix:
First Name:LORIN
Middle Name:ELAINE
Last Name:GUILLORY JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORIN
Other - Middle Name:GUILLORY
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 8500
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8500
Mailing Address - Country:US
Mailing Address - Phone:910-715-1010
Mailing Address - Fax:910-715-1026
Practice Address - Street 1:155 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8710
Practice Address - Country:US
Practice Address - Phone:910-715-2164
Practice Address - Fax:910-715-4493
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01884207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902562Medicaid
NC141C1OtherBCBS
NCNCA997AMedicare PIN