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NPI Code Detail

MEDICARE: DR. OMICI UWAGBAI COLQUITT M.D., M.P.H.

MEDICARE: DR. OMICI UWAGBAI COLQUITT M.D., M.P.H.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician2019-00622NC
2207QG0300XGeriatric Medicine (Family Medicine) Physician2019-00622NC

General Provider Information

NPI Number : 1043622343
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. OMICI UWAGBAI COLQUITT M.D., M.P.H.
Provider Business Mailing Address
First Line : PO BOX 746724
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6724
Country : US
Telephone Number : 312-733-9730
Fax Number :
Provider Business Practice Location Address
First Line : 906 BINGHAM DR
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28304-2842
Country : US
Telephone Number : 910-213-3547
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2014
Last Update Date : 01/15/2026

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