# FAYETTEVILLE FAMILY MEDICAL CARE, PA

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

## Provider details

- **NPI number:** 1073518536
- **Authorized official:** MRS. ALICE M KUGLER (ADMINISTRATOR)
- **Authorized official phone:** (910) 323-1718

## Contact information

- **Practice address:** 1307 AVON ST, FAYETTEVILLE, NC 28304-4423
- **Practice address phone:** (910) 323-1718
- **Practice address fax:** (910) 323-5701
- **Mailing address:** 1307 AVON ST, FAYETTEVILLE, NC 28304-4423
- **Mailing address phone:** (910) 323-1718
- **Mailing address fax:** (910) 323-5701

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/20/2005
- **Last updated:** 08/19/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 01559 | BCBS | — |
| 01 | — | 3442124 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |
| 05 | — | 8901559 | — | NC |