Provider Demographics
NPI:1568414720
Name:AGYEI-GYAMFI, KWADWO (MD)
Entity Type:Individual
Prefix:
First Name:KWADWO
Middle Name:
Last Name:AGYEI-GYAMFI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29I4 N ELM STREET
Mailing Address - Street 2:PMB # 130
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358
Mailing Address - Country:US
Mailing Address - Phone:910-739-5197
Mailing Address - Fax:910-739-5294
Practice Address - Street 1:4348 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2677
Practice Address - Country:US
Practice Address - Phone:910-739-2519
Practice Address - Fax:910-739-5294
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-00720207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH310917085141OtherCARESOURCE MEDICAID
P00158641OtherRR MEDICARE
OH2516218OtherMOLINA MEDICAID
NC5918266Medicaid
OH000000185265OtherUNISON MEDICAID
P00158641OtherRR MEDICARE
OH310917085141OtherCARESOURCE MEDICAID