Provider Demographics
NPI:1619139029
Name:BROOKS-LOCKLEAR, CHAMAINE RENEE (MD)
Entity type:Individual
Prefix:
First Name:CHAMAINE
Middle Name:RENEE
Last Name:BROOKS-LOCKLEAR
Suffix:
Gender:F
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:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28353-1847
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:910-276-0571
Practice Address - Street 1:500 LAUCHWOOD DR
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5501
Practice Address - Country:US
Practice Address - Phone:910-291-6904
Practice Address - Fax:910-291-6907
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30965207Q00000X
NC2011-00731207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC1479Medicaid
NC5918442Medicaid
NCNC2347BMedicare PIN
NC2347935Medicare PIN