Provider Demographics
NPI:1538227715
Name:LOCKLEAR, ROXANN (ARDMS)
Entity type:Individual
Prefix:
First Name:ROXANN
Middle Name:
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:ARDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4059
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-4059
Mailing Address - Country:US
Mailing Address - Phone:910-843-4629
Mailing Address - Fax:
Practice Address - Street 1:5277 MOUNT ZION CHURCH RD
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-9288
Practice Address - Country:US
Practice Address - Phone:910-843-4629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1001612471S1302X, 247100000X
NC247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty