Healthcare Provider Details

I. General information

NPI: 1194393769
Provider Name (Legal Business Name): FAITH PRIMARY CARE PLUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 SANFORD DR STE B
MORGANTON NC
28655-2576
US

IV. Provider business mailing address

329 SANFORD DR STE B
MORGANTON NC
28655-2576
US

V. Phone/Fax

Practice location:
  • Phone: 828-430-9120
  • Fax: 828-430-9122
Mailing address:
  • Phone: 828-430-9120
  • Fax: 828-430-9122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NGONDA'YEBENIT NZELLE NGO MAYEBA
Title or Position: ADMINISTRATOR
Credential:
Phone: 828-430-9120