Healthcare Provider Details

I. General information

NPI: 1831198761
Provider Name (Legal Business Name): CAROLINA KIDNEY CARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 SANDHURST DR
FAYETTEVILLE NC
28304
US

IV. Provider business mailing address

557 SANDHURST DR
FAYETTEVILLE NC
28304-4433
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-8114
  • Fax: 910-484-1564
Mailing address:
  • Phone: 910-484-8114
  • Fax: 910-484-1564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateNC

VIII. Authorized Official

Name: MOSES ABOAGYE-KUMI
Title or Position: PARTNER
Credential: MD
Phone: 910-500-6132