Provider Demographics
NPI:1639573348
Name:AFFORDABLE MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:AFFORDABLE MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:EMEAGWALI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:301-412-7990
Mailing Address - Street 1:6475 NEW HAMPSHIRE AVENUE
Mailing Address - Street 2:SUITE 430
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783
Mailing Address - Country:US
Mailing Address - Phone:240-670-8305
Mailing Address - Fax:240-670-8306
Practice Address - Street 1:6475 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 430
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3269
Practice Address - Country:US
Practice Address - Phone:240-670-8305
Practice Address - Fax:240-670-8306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR134072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4227221 00Medicaid
DC033825600Medicaid