Healthcare Provider Details

I. General information

NPI: 1043622343
Provider Name (Legal Business Name): OMICI UWAGBAI M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OMICI NIGERIA UWAGBAI M.D., M.P.H

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 ROCK MERRITT AVE
FORT BRAGG NC
28310-0003
US

IV. Provider business mailing address

2817 ROCK MERRITT
FORT BRAGG NC
28310-0001
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-8282
  • Fax: 910-907-7296
Mailing address:
  • Phone: 910-907-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2019-00622
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number2019-00622
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: