Provider Demographics
NPI:1487660700
Name:CELESTINE I. AMAEFULE, M.D. PC
Entity Type:Organization
Organization Name:CELESTINE I. AMAEFULE, M.D. PC
Other - Org Name:GOLDSBORO QUICK CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CELESTINE
Authorized Official - Middle Name:I
Authorized Official - Last Name:AMAEFULE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-734-6700
Mailing Address - Street 1:1104 GRACIE PL
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-2260
Mailing Address - Country:US
Mailing Address - Phone:919-734-6700
Mailing Address - Fax:919-734-5651
Practice Address - Street 1:1104 GRACIE PL
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-2260
Practice Address - Country:US
Practice Address - Phone:919-734-6700
Practice Address - Fax:919-734-5651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8910514Medicaid
NCDR0723OtherPALMETTO GBA
NCDR0723OtherPALMETTO GBA