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General NPI Number Information
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NPI Number | 1467759985
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Entity Type | Organization
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Legal Business Name | SHALOM MEDICAL PC
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Dates
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Enumeration Date | 02/18/2011
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Last Update Date | 02/18/2011
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Provider Practice Location Address
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Address Line | 1102 HENDERSON DR
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City | JACKSONVILLE
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State | NC
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Zip | 28540-5203
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Country | US
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Telephone | 731-334-9011
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Fax | 731-288-1628
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Provider Business Mailing Address
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Address Line | 1102 HENDERSON DR
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City | JACKSONVILLE
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State | NC
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Zip | 28540-5203
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Country | US
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Telephone | 731-334-9011
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Fax | 731-288-1628
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/PRESIDENT
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Name | DR. BENJAMIN CHUKWUNONSO MOZIE
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Credential | MD
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Telephone | 731-334-9011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 2010-01876
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License Number State | NC
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