George Uchenna Agbakoba II, MD
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Fayetteville, NC
NPI 1467208348 · NPPES record last updated Apr 30, 2024
Key facts
- NPI
- 1467208348
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 1638 Owen Dr
Fayetteville, NC 28304-3424 - Phone
- (910) 615-3780
- Fax
- (910) 615-9907
- NPI assigned
- Apr 30, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240906000192 | NC | Order and Referring Only - Internal Medicine |
5395285209 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
1638 Owen Dr
Fayetteville, NC 28304-3424
Mailing address
1638 Owen Dr
Fayetteville, NC 28304-3424
Phone (910) 615-3780
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All providers in Fayetteville, NC · Student in an Organized Health Care Education/Training Program in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.