Organization
FAYETTEVILLE FAMILY MEDICAL CARE, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALICE M KUGLER (ADMINISTRATOR)
(910) 323-1718
Entity
Organization
Contact information
Practice address
1307 AVON ST, FAYETTEVILLE, NC 28304-4423
(910) 323-1718
(910) 323-5701
Mailing address
1307 AVON ST, FAYETTEVILLE, NC 28304-4423
(910) 323-1718
(910) 323-5701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01559
BCBS
—
01
—
3442124
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
8901559
—
NC
Enumeration date
06/20/2005
Last updated
08/19/2015
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