Healthcare Provider Details

I. General information

NPI: 1205740925
Provider Name (Legal Business Name): AGYAMAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2732 N CHATHAM CT
WINTERVILLE NC
28590-7915
US

IV. Provider business mailing address

2732 N CHATHAM CT
WINTERVILLE NC
28590-7915
US

V. Phone/Fax

Practice location:
  • Phone: 910-617-8379
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOCELYN FONG
Title or Position: PRESIDENT
Credential:
Phone: 910-617-8379