Provider Demographics
NPI:1588816482
Name:CAROLINA INFECTIOUS DISEASES CONSULTANTS PC
Entity Type:Organization
Organization Name:CAROLINA INFECTIOUS DISEASES CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OBIEFUNA
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:OKOYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD,MPH
Authorized Official - Phone:910-738-3434
Mailing Address - Street 1:3771 RAMSEY ST
Mailing Address - Street 2:SUITE 109-144
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-7675
Mailing Address - Country:US
Mailing Address - Phone:910-738-3434
Mailing Address - Fax:
Practice Address - Street 1:395 W 27TH ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3018
Practice Address - Country:US
Practice Address - Phone:910-738-3434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty