Healthcare Provider Details

I. General information

NPI: 1447928957
Provider Name (Legal Business Name): A PLUS FAMILY CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4551 NEW BERN AVE STE 160
RALEIGH NC
27610-1552
US

IV. Provider business mailing address

PO BOX 10492
RALEIGH NC
27605-0492
US

V. Phone/Fax

Practice location:
  • Phone: 919-556-1008
  • Fax: 919-556-6099
Mailing address:
  • Phone: 919-654-7309
  • Fax: 919-651-1045

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 Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: WANETT T MIMS
Title or Position: PRESIDENT
Credential:
Phone: 919-654-7309