Organization
AVE MARIA FAMILY PRACTICE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOROTHY EJINKONYE AGBAFE-MOSLEY MD (MEDICAL DIRECTOR)
(910) 799-5452
Entity
Organization
Contact information
Practice address
1230 MEDICAL CENTER DR, WILMINGTON, NC 28401
(910) 799-5452
(910) 799-5479
Mailing address
PO BOX 16663, WILMINGTON, NC 28408-6663
(910) 799-5452
(910) 799-5479
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2009-01999
NC
261QP2300X
Primary Care Clinic/Center
179288
NC
261QP2300X
Primary Care Clinic/Center
2009-01999
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5915683
—
NC
Enumeration date
12/01/2011
Last updated
07/17/2018
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