Individual
DR. SHADRACK ANSONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1638 OWEN DR, FAYETTEVILLE, NC 28304-3424
(910) 615-3960
Mailing address
1638 OWEN DR, FAYETTEVILLE, NC 28304-3424
(910) 615-3960
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2024-03249
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
04/05/2022
Last updated
07/31/2025
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