Healthcare Provider Details

I. General information

NPI: 1487847273
Provider Name (Legal Business Name): AMANZE UGOJI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 W D ST
NORTH WILKESBORO NC
28659-3506
US

IV. Provider business mailing address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-0001
US

V. Phone/Fax

Practice location:
  • Phone: 336-651-8294
  • Fax:
Mailing address:
  • Phone: 336-716-9252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2007-00241
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number2007-00241
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2007-00241
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: