Marietta Medical Clinic, PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

200200150 Issued in NC

Legal business name

MARIETTA MEDICAL CLINIC, PA

Practice address

401 S Marietta St
Gastonia, NC 28052-4331

Phone

(704) 866-8030

NPI assigned

Dec 2, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Ifeanyi O Okafor, MD

Title

President

Phone

(704) 866-8030

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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

• Ifeanyichukwu Obiora Okafor, MD

  • Internal Medicine Physician
  • Lincolnton, NC
  • NPI 1972692366
  NPD (past)
• Charles K Agunobi, M.D.

  • Internal Medicine Physician
  • Duluth, GA
  • NPI 1609864446
  NPD (past)

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

{
    "created_epoch": "1228176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236816000000",
    "number": "1912142167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 550457",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280550457",
            "telephone_number": "704-866-8030"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIETTA MEDICAL CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-02",
        "last_updated": "2009-03-12",
        "status": "A",
        "authorized_official_last_name": "OKAFOR",
        "authorized_official_first_name": "IFEANYI",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-866-8030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NC",
            "license": "200200150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 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
• Randall David Marosok, M.D.

• Specialist in Gastonia, NC
• Providers in Gastonia, NC by specialty
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 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.