Organization
FAITH MEDICAL CENTER P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOEL A ONAFOWOKAN MD (MEDICAL DIRECTOR)
(704) 771-8400
Entity
Organization
Contact information
Practice address
3626 LATROBE DR, CHARLOTTE, NC 28211-1388
(704) 366-7182
(704) 366-7184
Mailing address
3626 LATROBE DR, CHARLOTTE, NC 28211-1388
(704) 366-7182
(704) 366-7184
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
261Q00000X
Clinic/Center
Primary
200401292
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1406K
BLUECROSS BLUESHIELD OF NORTH CAROLINA
NC
05
—
5902366
—
NC
Enumeration date
03/25/2009
Last updated
08/03/2020
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