NPIMap

Organization Active NPI

Fayetteville Medical Clinic, PC

  • Internal Medicine Physician
  • Fayetteville, NC
National Provider Identifier
1285873018
Registry record updated Feb 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
FAYETTEVILLE MEDICAL CLINIC, PC
Practice address
3613 Raeford Rd
Suite C
Fayetteville, NC 28304-2113
Phone
(910) 483-7506
Fax
(910) 483-1749
NPI assigned
Feb 18, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2009

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

Authorized official

Name
Dr. Agodichi U Nwosu, M.D.NPI 1902942931
Title
Director/Owner
Phone
(910) 483-7506

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

3613 Raeford Rd
Suite C
Fayetteville, NC 28304-2113

Mailing address

3613 Raeford Rd
Suite C
Fayetteville, NC 28304-2113
Phone (910) 483-7506

National Provider Directory

National Provider Directory

Locations

3613 Raeford Rd
Ste C
Fayetteville, NC 28304
Phone (910) 483-7506

Practitioners & affiliated clinicians

Practitioners 7

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": "1234915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234915200000",
    "number": "1285873018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3613 RAEFORD RD",
            "address_2": "SUITE C",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283042113",
            "telephone_number": "910-483-7506",
            "fax_number": "910-483-1749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3613 RAEFORD RD",
            "address_2": "SUITE C",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283042113",
            "telephone_number": "910-483-7506",
            "fax_number": "910-483-1749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTEVILLE MEDICAL CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-18",
        "last_updated": "2009-02-18",
        "status": "A",
        "authorized_official_last_name": "NWOSU",
        "authorized_official_first_name": "AGODICHI",
        "authorized_official_middle_name": "U",
        "authorized_official_title_or_position": "DIRECTOR/OWNER",
        "authorized_official_telephone_number": "910-483-7506",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal 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 18, 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.