Healthcare Provider Details

I. General information

NPI: 1073454427
Provider Name (Legal Business Name): MR. EMMANUEL TULIKUMWE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 FERN AVE
HIGH POINT NC
27260-5521
US

IV. Provider business mailing address

1911 FERN AVE
HIGH POINT NC
27260-5521
US

V. Phone/Fax

Practice location:
  • Phone: 336-456-8666
  • Fax:
Mailing address:
  • Phone: 336-456-8666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number000038681791
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: