Organization
GRACEFUL AGING,PC
Active
Organization
GRACEFUL AGING,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSANNAH OGUNWO M.D. (PRESIDENT)
(910) 868-6477
Entity
Organization
Contact information
Practice address
2732 BARDOLINO DR, FAYETTEVILLE, NC 28306-4636
(910) 868-6477
Mailing address
PO BOX 87142, FAYETTEVILLE, NC 28304-7142
(910) 868-6477
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
200601059
NC
Other
Enumeration date
07/09/2010
Last updated
07/09/2010
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