# RENEWED AXIS TELEHEALTH PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063301612
- **Authorized official:** NINA FOMBUH FNP-BC (OWNER/PROVIDER)
- **Authorized official phone:** (047) 741-2909

## Contact information

- **Practice address:** 2101 SARDIS RD N STE 120B, CHARLOTTE, NC 28227-7711
- **Practice address phone:** (704) 840-2927
- **Mailing address:** 2101 SARDIS RD N STE 120B, CHARLOTTE, NC 28227-7711
- **Mailing address phone:** (508) 840-2926

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/30/2025
- **Last updated:** 02/02/2026