MEDICARE: DR. IFEYINWA JULIANA OKONKWO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	2007-01791	NC
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	2007-01791	NC

General Provider Information

NPI Number	:	1154502185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IFEYINWA JULIANA OKONKWO MD

Provider Business Mailing Address
First Line	:	101 ROBESON ST STE 202
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28301-5520
Country	:	US
Telephone Number	:	910-615-1630
Fax Number	:	910-615-1636

Provider Business Practice Location Address
First Line	:	101 ROBESON ST
Second Line	:	SUITE 203
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28301-5552
Country	:	US
Telephone Number	:	910-609-1630
Fax Number	:	910-609-1636

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2007
Last Update Date	:	05/13/2026

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