| Faith Medical Center P.c. | |
|
3626 Latrobe Dr Charlotte NC 28211-1388 | |
| (704) 366-7182 | |
| (704) 366-7184 |
| Full Name | Faith Medical Center P.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 3626 Latrobe Dr, Charlotte, North Carolina |
| Authorized Official Name and Position | Joel A Onafowokan (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7047718400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Faith Medical Center P.c. 3626 Latrobe Dr Charlotte NC 28211-1388 Ph: (704) 366-7182 | Faith Medical Center P.c. 3626 Latrobe Dr Charlotte NC 28211-1388 Ph: (704) 366-7182 |
| NPI Number | 1992947766 |
|---|---|
| Provider Enumeration Date | 03/25/2009 |
| Last Update Date | 08/03/2020 |
| Certification Date | 08/03/2020 |
| Medicare PECOS PAC ID | 5496802803 |
|---|---|
| Medicare Enrollment ID | O20090421000637 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992947766 | NPI | - | NPPES |
| 5902366 | Medicaid | NC | |
| 1406K | Other | NC | BLUECROSS BLUESHIELD OF NORTH CAROLINA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084A0401X | Psychiatry & Neurology - Addiction Medicine | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | 200401292 (North Carolina) | Primary |
| Provider Name | Joel A Onafowokan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790745495 PECOS PAC ID: 2769401389 Enrollment ID: I20051114000377 |
| Provider Name | Ambrosha N Jordan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700027307 PECOS PAC ID: 6406906999 Enrollment ID: I20090603000483 |
| Provider Name | Bezawit Abebe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114583358 PECOS PAC ID: 8426479031 Enrollment ID: I20200608002095 |
| Provider Name | Chidinma Oligbo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023885944 PECOS PAC ID: 9739528092 Enrollment ID: I20240418003666 |
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