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General NPI Number Information
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NPI Number | 1457335507
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Entity Type | Organization
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Legal Business Name | CAROLINA SURGICAL SPECIALISTS, PA
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Dates
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Enumeration Date | 12/02/2005
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Last Update Date | 08/08/2014
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Provider Practice Location Address
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Address Line | 1220 WALTER REED RD SUITE 102
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-4430
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Country | US
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Telephone | 910-426-2224
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Fax | 910-826-2228
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Provider Business Mailing Address
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Address Line | 1220 WALTER REED RD SUITE 102
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-4430
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Country | US
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Telephone | 910-426-2224
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Fax | 910-826-2228
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OBINNA CHUKWUDI IGWILO
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Credential | M.D.
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Telephone | 910-426-2224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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