Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Logan Mock, PA

Individual provider Physician Assistant · NPI 1578180006

Logan Mock, PA is a Physician Assistant in Lillington, North Carolina. Qualified in 2020, 6 years ago. Practices with Southeastern Radiation Oncology, a 6-clinician group, works from 2 locations and accepts Medicare assignment.

Years since qualifying
6
In the registry since
2020
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

215 Brightwater Dr
Lillington, NC 27546-5156
Phone: (704) 765-2578
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1638 Owen Dr, Fayetteville, NC 28304-3424 — (843) 726-1470

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1578180006
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorYes
NPI enumeratedJune 30, 2020
Last updated in NPPESNovember 20, 2024
Certification dateNovember 20, 2024
Mailing address200 Queens Rd Ste 400, Charlotte, NC 28204-3264

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Southeastern Radiation Oncology — 6 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Lillington