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General NPI Number Information
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NPI Number | 1891667861
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Entity Type | Organization
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Legal Business Name | AGE-UNDEFINED, PLLC
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Dates
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Enumeration Date | 09/19/2025
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 2625 RAEFORD RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-5471
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Country | US
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Telephone | 910-286-6335
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Fax | 910-786-1602
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Provider Business Mailing Address
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Address Line | 2501 LOCKWOOD RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-5026
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Country | US
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Telephone | 910-286-6335
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Fax | 910-786-1602
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. SCOTT FESTA
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Credential | DMSC
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Telephone | 910-286-6335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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