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General NPI Number Information
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NPI Number | 1326821158
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Entity Type | Organization
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Legal Business Name | COMPLETE CARE DIRECT PRIMARY CARE, LLC
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Dates
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Enumeration Date | 08/15/2023
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 301 S MCDOWELL ST STE 125-1350
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City | CHARLOTTE
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State | NC
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Zip | 28204-2623
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Country | US
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Telephone | 803-855-1707
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Fax | 803-274-2532
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Provider Business Mailing Address
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Address Line | 3210 N PLEASANTBURG DR # 1098
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City | GREENVILLE
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State | SC
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Zip | 29609-2925
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Country | US
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Telephone | 803-855-1707
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Fax | 803-274-2532
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Authorized Official
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Title or Position | OWNER
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Name | DR. BUKIE A ADEFABI
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Credential |
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Telephone | 803-855-1707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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