Healthcare Provider Details

I. General information

NPI: 1669448791
Provider Name (Legal Business Name): NICOLE OGG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N MAIN ST
WEAVERVILLE NC
28787-8230
US

IV. Provider business mailing address

104 N MAIN ST
WEAVERVILLE NC
28787-8230
US

V. Phone/Fax

Practice location:
  • Phone: 828-645-7974
  • Fax: 828-645-9798
Mailing address:
  • Phone: 828-645-7974
  • Fax: 828-645-9798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9901454
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: