Marietta Medical Clinic PA

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

MARIETTA MEDICAL CLINIC PA

Practice address

401 S Marietta St
Gastonia, NC 28052-4331

Phone

(704) 866-8030

Fax

(704) 866-8717

NPI assigned

Jun 24, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Charles K Agunobi, MD

Title

Physician

Phone

(704) 866-8030

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245801600000",
    "number": "1215165659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 S MARIETTA ST",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280524331",
            "telephone_number": "704-866-8030",
            "fax_number": "704-866-8717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 S MARIETTA ST",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280524331",
            "telephone_number": "704-866-8030",
            "fax_number": "704-866-8717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIETTA MEDICAL CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-24",
        "last_updated": "2009-06-24",
        "status": "A",
        "authorized_official_last_name": "AGUNOBI",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "704-866-8030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5950793",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stefanie Renee Mann, LCMHC
• Melissa Ann Manners, CRNA
• Gregory Allen Mantooth, M.D.
• Imiah Mapp
• Sierra Margarita
• Marietta Medical Clinic, PA
• Harish Marisiddaiah, M.D.
• Mark E. Taylor, DDS, PA
• Caitlin Mezey Marlow, CNM
• Emily McCotter Marlowe, MA CCC-SLP

• Clinic/Center in Gastonia, NC
• Providers in Gastonia, NC by specialty
• Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.