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NPI Code Detail

MEDICARE: ATLANTIC MEDICAL GROUP

MEDICARE: ATLANTIC MEDICAL GROUP
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
1207RG0100XGastroenterology Physician200401229NC

General Provider Information

NPI Number : 1962728394
Entity Type Code : Organization
Provider Name (Legal Business Name) : ATLANTIC MEDICAL GROUP
Provider Business Mailing Address
First Line : 4 JOSH COURT
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28546-5253
Country : US
Telephone Number : 910-577-3636
Fax Number : 910-353-5635
Provider Business Practice Location Address
First Line : 4 JOSH COURT
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28546-5253
Country : US
Telephone Number : 910-577-3636
Fax Number :
Authorized Official
Title or Position : OWNER/PROVIDER
Name : IKECHUKWU ERIC IBEGBU
Credential : M.D.
Telephone Number : 910-577-3636
Provider Enumeration Date : 04/09/2010
Last Update Date : 03/03/2017

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Directions to “ATLANTIC MEDICAL GROUP ” Practice Location

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