Healthcare Provider Details

I. General information

NPI: 1205752284
Provider Name (Legal Business Name): ADOLF A AGHOGAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 FULTON ST
DURHAM NC
27705-3875
US

IV. Provider business mailing address

1099 MATCHSTICK PL SW
CONCORD NC
28025-4706
US

V. Phone/Fax

Practice location:
  • Phone: 704-340-3893
  • Fax:
Mailing address:
  • Phone: 704-340-3893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number206035
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: