Healthcare Provider Details

I. General information

NPI: 1346346889
Provider Name (Legal Business Name): KINGSLEY UZO OKOROAFOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 AVON ST STE 103
FAYETTEVILLE NC
28304-4423
US

IV. Provider business mailing address

1315 AVON ST STE 103
FAYETTEVILLE NC
28304-4423
US

V. Phone/Fax

Practice location:
  • Phone: 910-703-8718
  • Fax: 910-703-8721
Mailing address:
  • Phone: 910-703-8718
  • Fax: 910-703-8721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number200500969
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number200500969
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: