Healthcare Provider Details

I. General information

NPI: 1629852587
Provider Name (Legal Business Name): MAWADA ABBAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 TARBORO ST SW
WILSON NC
27893-3437
US

IV. Provider business mailing address

4913 SUMMIT PL NW APT 807
WILSON NC
27896-8169
US

V. Phone/Fax

Practice location:
  • Phone: 252-399-8040
  • Fax:
Mailing address:
  • Phone: 810-830-4274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2025-03705
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: