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6387 Ramsey St Unit 210 Fayetteville NC 28311-9442 | |
| (910) 615-3920 | |
| (910) 321-6221 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 6387 Ramsey St Unit 210, Fayetteville, North Carolina |
| Authorized Official Name and Position | Joseph Fiser (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9106155572 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1638 Owen Drive Attn: Managed Care Planning Fayetteville NC 28304 Ph: (910) 615-6949 | 6387 Ramsey St Unit 210 Fayetteville NC 28311-9442 Ph: (910) 615-3920 |
| NPI Number | 1003818485 |
|---|---|
| Provider Enumeration Date | 08/15/2005 |
| Last Update Date | 01/19/2024 |
| Medicare PECOS PAC ID | 5193784494 |
|---|---|
| Medicare Enrollment ID | O20041004000352 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003818485 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Godfrey E Ohadugha |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902809510 PECOS PAC ID: 6901896265 Enrollment ID: I20040517001588 |
| Provider Name | Ram Mohan Rao Bongu |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1760485080 PECOS PAC ID: 0547275000 Enrollment ID: I20060221000060 |
| Provider Name | Cecilia V Ainolhayat |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255397105 PECOS PAC ID: 6507951084 Enrollment ID: I20070927001087 |
| Provider Name | Jamila Devora Rouse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083245476 PECOS PAC ID: 4981035656 Enrollment ID: I20200513000566 |
| Provider Name | April Adams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750810859 PECOS PAC ID: 6002176427 Enrollment ID: I20200820002590 |
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