Provider Demographics
NPI:1548365364
Name:SHULL, LONNIE NEWELL JR (MD)
Entity type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:NEWELL
Last Name:SHULL
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1648
Mailing Address - Street 2:401 MULBERRY ST SW STE 101
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-1648
Mailing Address - Country:US
Mailing Address - Phone:828-758-5501
Mailing Address - Fax:828-758-0080
Practice Address - Street 1:401 MULBERRY ST SW
Practice Address - Street 2:STE 101
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-1648
Practice Address - Country:US
Practice Address - Phone:828-758-5501
Practice Address - Fax:828-758-0080
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2010-01-05
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Provider Licenses
StateLicense IDTaxonomies
NC19190208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC76087OtherBCBS
NC8976087Medicaid
NC210398Medicare ID - Type Unspecified
NC8976087Medicaid