# LAKE WACCAMAW PRIMARY CARE, PLLC

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

## Provider details

- **NPI number:** 1477795821
- **Authorized official:** AMY G GAWEDA FNP (PRESIDENT)
- **Authorized official phone:** (910) 646-6617

## Contact information

- **Practice address:** 107 CHURCH ST, LAKE WACCAMAW, NC 28450-1908
- **Practice address phone:** (910) 646-6617
- **Practice address fax:** (910) 646-6620
- **Mailing address:** 121 BRETONSHIRE RD, WILMINGTON, NC 28405-4001
- **Mailing address phone:** (910) 617-6202

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 92226 | NC | Yes |

## Other

- **Enumeration date:** 04/01/2009
- **Last updated:** 04/01/2009