Healthcare Provider Details

I. General information

NPI: 1740507151
Provider Name (Legal Business Name): NGWE ACHIRIMOFOR AYCOCK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2010
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 N GRAHAM HOPEDALE RD
BURLINGTON NC
27217-2971
US

IV. Provider business mailing address

221 N GRAHAM HOPEDALE RD
BURLINGTON NC
27217-2971
US

V. Phone/Fax

Practice location:
  • Phone: 336-570-3739
  • Fax: 336-570-1215
Mailing address:
  • Phone: 336-570-3739
  • Fax: 336-570-1215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number2013-00746
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2013-00746
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: