Healthcare Provider Details

I. General information

NPI: 1447295159
Provider Name (Legal Business Name): ADANMA MBADINUJU OKWARA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADANMA IJEOMA MBADINUJU MD

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 10/04/2025
Certification Date: 10/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 S SUTHERLAND AVE
MONROE NC
28112-5060
US

IV. Provider business mailing address

404 S SUTHERLAND AVE
MONROE NC
28112-5060
US

V. Phone/Fax

Practice location:
  • Phone: 704-291-9267
  • Fax: 704-776-4078
Mailing address:
  • Phone: 704-291-9267
  • Fax: 704-283-7939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200501741
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: