Healthcare Provider Details

I. General information

NPI: 1013165695
Provider Name (Legal Business Name): LOUISA APONGSE AYAFOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113B HERTFORD COUNTY HIGH RD
AHOSKIE NC
27910-8131
US

IV. Provider business mailing address

3636 HIGH ST
PORTSMOUTH VA
23707-3236
US

V. Phone/Fax

Practice location:
  • Phone: 252-209-8161
  • Fax: 252-209-6011
Mailing address:
  • Phone: 252-209-8161
  • Fax: 252-209-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2011-01957
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: