Provider Demographics
NPI:1598752198
Name:ONIME, GODFREY DELE (MD)
Entity Type:Individual
Prefix:
First Name:GODFREY
Middle Name:DELE
Last Name:ONIME
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 1:4900 FAYETTEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2110
Mailing Address - Country:US
Mailing Address - Phone:910-739-8899
Mailing Address - Fax:910-738-7174
Practice Address - Street 1:4900 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2110
Practice Address - Country:US
Practice Address - Phone:910-739-8899
Practice Address - Fax:910-738-7174
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002-01138207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89133KFMedicaid
NC133KFOtherBLUE CROSS BLUE SHIELD
NC2012184AMedicare ID - Type Unspecified
NC89133KFMedicaid