# AVE MARIA FAMILY PRACTICE, PLLC

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

## Provider details

- **NPI number:** 1215205539
- **Authorized official:** DR. DOROTHY EJINKONYE AGBAFE-MOSLEY MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (910) 799-5452

## Contact information

- **Practice address:** 1230 MEDICAL CENTER DR, WILMINGTON, NC 28401
- **Practice address phone:** (910) 799-5452
- **Practice address fax:** (910) 799-5479
- **Mailing address:** PO BOX 16663, WILMINGTON, NC 28408-6663
- **Mailing address phone:** (910) 799-5452
- **Mailing address fax:** (910) 799-5479

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 2009-01999 | NC | Yes |
| 261QP2300X | Primary Care Clinic/Center | 179288 | NC | — |
| 261QP2300X | Primary Care Clinic/Center | 2009-01999 | NC | — |

## Other

- **Enumeration date:** 12/01/2011
- **Last updated:** 07/17/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5915683 | — | NC |