Healthcare Provider Details

I. General information

NPI: 1851907604
Provider Name (Legal Business Name): PRIMARY CARE OF NORTH CAROLINA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 STONEHAVEN DR
CHARLOTTE NC
28215-3232
US

IV. Provider business mailing address

2409 MURCHISON RD
FAYETTEVILLE NC
28301-3519
US

V. Phone/Fax

Practice location:
  • Phone: 727-641-9107
  • Fax:
Mailing address:
  • Phone: 706-589-1927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHIOMA BLESSING EJIOGU
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 727-641-9107