Organization
PRIME HEALTH MEDICAL CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SYLVESTER I OGBATA MD (OWNER)
(203) 545-9119
Entity
Organization
Contact information
Practice address
1400 MEDFORD DR, CHARLOTTE, NC 28205-5624
(704) 940-5588
(704) 940-5589
Mailing address
7619 BERRYFIELD CT, WAXHAW, NC 28173-9817
(203) 545-9119
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
—
207RN0300X
Nephrology Physician
Primary
—
—
Other
Enumeration date
12/20/2011
Last updated
09/23/2021
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