Graceful Aging,PC

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

License

200601059 Issued in NC

Legal business name

GRACEFUL AGING,PC

Practice address

2732 Bardolino Dr
Fayetteville, NC 28306-4636

Phone

(910) 868-6477

NPI assigned

Jul 9, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Susannah Ogunwo, M.D.

Title

President

Phone

(910) 868-6477

Specialties & licenses 1

Addresses

Practitioners 1

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

• Adewale Ogunwo, NP

  • Gerontology Nurse Practitioner
  • Fayetteville, NC
  • NPI 1225301708
  NPD (past)

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

{
    "created_epoch": "1278633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278633600000",
    "number": "1316259013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 87142",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283047142",
            "telephone_number": "910-868-6477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2732 BARDOLINO DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283064636",
            "telephone_number": "910-868-6477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACEFUL AGING,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-09",
        "last_updated": "2010-07-09",
        "status": "A",
        "authorized_official_last_name": "OGUNWO",
        "authorized_official_first_name": "SUSANNAH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-868-6477",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NC",
            "license": "200601059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey Marie Graber
• Grace & Empathy Collective
• Grace and Mercy Healthcare Services Incorporated
• Grace Behavioral Health PLLC
• Grace Care Inc.
• Graceland Manor & Associates, Inc
• Gracepoint Behavior Consulting LLC
• Averi Jordan Grady Brown, PA-C
• Alexandria Danielle Grady, LCSWA
• Graham Chiropractic & Health

• Geriatric Medicine (Family Medicine) Physician in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Geriatric Medicine (Family Medicine) Physician in North Carolina

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