Healthcare Provider Details

I. General information

NPI: 1811121007
Provider Name (Legal Business Name): FULL CARE MEDICAL CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 NUMBER TEN ST
CLINCHCO VA
24226
US

IV. Provider business mailing address

P O BOX 356
CLINCHCO VA
24226-0356
US

V. Phone/Fax

Practice location:
  • Phone: 276-835-1122
  • Fax:
Mailing address:
  • Phone: 276-835-1122
  • Fax: 276-835-8577

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 Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES ABROKWAH
Title or Position: PRESIDENT/DIRECTOR
Credential: M.D.
Phone: 272-835-1122