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General NPI Number Information
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NPI Number | 1992947766
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Entity Type | Organization
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Legal Business Name | FAITH MEDICAL CENTER P.C.
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Dates
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Enumeration Date | 03/25/2009
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 3626 LATROBE DR
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City | CHARLOTTE
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State | NC
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Zip | 28211-1388
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Country | US
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Telephone | 704-366-7182
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Fax | 704-366-7184
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Provider Business Mailing Address
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Address Line | 3626 LATROBE DR
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City | CHARLOTTE
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State | NC
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Zip | 28211-1388
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Country | US
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Telephone | 704-366-7182
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Fax | 704-366-7184
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JOEL A ONAFOWOKAN
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Credential | MD
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Telephone | 704-771-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 200401292
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License Number State | NC
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