Healthcare Provider Details

I. General information

NPI: 1558713347
Provider Name (Legal Business Name): ABENA ASIEDUA OWUSU-BANAHENE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 JEFFERSON ST
WHITEVILLE NC
28472-3634
US

IV. Provider business mailing address

PO BOX 19305
CHARLOTTE NC
28219-9305
US

V. Phone/Fax

Practice location:
  • Phone: 910-642-8011
  • Fax:
Mailing address:
  • Phone: 910-642-8011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2020-03238
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2020-03238
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2020-03238
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: