Provider Demographics
NPI:1558647768
Name:FRESH CARE WALK IN CLINIC, PLLC
Entity Type:Organization
Organization Name:FRESH CARE WALK IN CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:K
Authorized Official - Last Name:AJMANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-619-3591
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27331-0400
Mailing Address - Country:US
Mailing Address - Phone:919-842-3224
Mailing Address - Fax:919-776-0511
Practice Address - Street 1:101 S VANCE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4239
Practice Address - Country:US
Practice Address - Phone:919-842-3224
Practice Address - Fax:919-776-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC176256261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care