Provider Demographics
NPI:1477197168
Name:DIVINE FAMILY PRACTICE AND URGENT CARE, PLLC
Entity Type:Organization
Organization Name:DIVINE FAMILY PRACTICE AND URGENT CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABIMBOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNLEYE-KOLAWOLE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C
Authorized Official - Phone:910-779-0780
Mailing Address - Street 1:3616 CAPE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4456
Mailing Address - Country:US
Mailing Address - Phone:910-779-0780
Mailing Address - Fax:910-779-0896
Practice Address - Street 1:3616 CAPE CENTER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4456
Practice Address - Country:US
Practice Address - Phone:910-779-0780
Practice Address - Fax:910-779-0896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-05
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center