Healthcare Provider Details

I. General information

NPI: 1922963529
Provider Name (Legal Business Name): FIRST CARE MEDICAL CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7004 SMITH CORNERS BLVD STE A
CHARLOTTE NC
28269-3827
US

IV. Provider business mailing address

404 S SUTHERLAND AVE
MONROE NC
28112-5060
US

V. Phone/Fax

Practice location:
  • Phone: 704-291-9267
  • Fax:
Mailing address:
  • Phone: 704-291-9267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BENEDICT O OKWARA
Title or Position: OWNER / MEDICAL DIRECTOR
Credential: MD
Phone: 704-291-9267