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General NPI Number Information
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NPI Number | 1558647768
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Entity Type | Organization
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Legal Business Name | FRESH CARE WALK IN CLINIC, PLLC
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 101 S VANCE ST
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City | SANFORD
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State | NC
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Zip | 27330-4239
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Country | US
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Telephone | 919-842-3224
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Fax | 919-776-0511
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Provider Business Mailing Address
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Address Line | PO BOX 400
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City | SANFORD
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State | NC
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Zip | 27331-0400
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Country | US
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Telephone | 919-842-3224
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Fax | 919-776-0511
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Authorized Official
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Title or Position | CEO
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Name | DR. AJAY K AJMANI
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Credential | M.D.
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Telephone | 919-619-3591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 176256
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License Number State | NC
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