| Fayetteville Urgent Care & Family Medicine, Llc | |
|
4155 Ferncreek Dr Ste 102 Fayetteville NC 28314-2576 | |
| (910) 425-5999 | |
| (910) 221-1062 |
| Full Name | Fayetteville Urgent Care & Family Medicine, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4155 Ferncreek Dr Ste 102, Fayetteville, North Carolina |
| Authorized Official Name and Position | Godfrey Fondinka (MEDICAL DIRECTOR) |
| Authorized Official Contact | 9104255999 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fayetteville Urgent Care & Family Medicine, Llc 4155 Ferncreek Dr Ste 102 Fayetteville NC 28314-2576 Ph: (910) 425-5999 | Fayetteville Urgent Care & Family Medicine, Llc 4155 Ferncreek Dr Ste 102 Fayetteville NC 28314-2576 Ph: (910) 425-5999 |
| NPI Number | 1891060398 |
|---|---|
| Provider Enumeration Date | 03/16/2012 |
| Last Update Date | 05/26/2021 |
| Medicare PECOS PAC ID | 1355504481 |
|---|---|
| Medicare Enrollment ID | O20120529000410 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891060398 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 200301461 (North Carolina) | Secondary |
| 261QU0200X | Clinic/center - Urgent Care | 200301461 (North Carolina) | Primary |
| Provider Name | Suriya B Jayawardena |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1336338268 PECOS PAC ID: 6901920776 Enrollment ID: I20100831000413 |
| Provider Name | Ngonda'yebenit Ngo Mayeba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598020430 PECOS PAC ID: 0840536504 Enrollment ID: I20190116004000 |
| Provider Name | Helen Young Yates |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487264370 PECOS PAC ID: 6800264748 Enrollment ID: I20221123002606 |
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