NPIMap

Organization Active NPI

Buckhead Express Clinic PC

  • Family Medicine Physician
  • Fayetteville, NC
National Provider Identifier
1255661302
Registry record updated Feb 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BUCKHEAD EXPRESS CLINIC PC
Practice address
3613A Raeford Rd
Fayetteville, NC 28304-2113
Phone
(910) 483-1493
Fax
(910) 920-4212
NPI assigned
Jan 12, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2010

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

Authorized official

Name
Agodi U Nwosu, MD
Title
President
Phone
(910) 483-1493

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

3613A Raeford Rd
Fayetteville, NC 28304-2113

Mailing address

3613A Raeford Rd
Fayetteville, NC 28304-2113
Phone (910) 483-1493

National Provider Directory

National Provider Directory

Locations

3613A Raeford Rd
Fayetteville, NC 28304
Phone (910) 483-1493

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1263254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265673600000",
    "number": "1255661302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3613A RAEFORD RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283042113",
            "telephone_number": "910-483-1493",
            "fax_number": "910-920-4212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3613A RAEFORD RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283042113",
            "telephone_number": "910-483-1493",
            "fax_number": "910-920-4212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUCKHEAD EXPRESS CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-12",
        "last_updated": "2010-02-09",
        "status": "A",
        "authorized_official_last_name": "NWOSU",
        "authorized_official_first_name": "AGODI",
        "authorized_official_middle_name": "U",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-483-1493",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2010; 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.