Organization
MARIETTA MEDICAL CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES K AGUNOBI MD (PHYSICIAN)
(704) 866-8030
Entity
Organization
Contact information
Practice address
401 S MARIETTA ST, GASTONIA, NC 28052-4331
(704) 866-8030
(704) 866-8717
Mailing address
401 S MARIETTA ST, GASTONIA, NC 28052-4331
(704) 866-8030
(704) 866-8717
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5950793
—
NC
Enumeration date
06/24/2009
Last updated
06/24/2009
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