Provider Demographics
NPI:1083434963
Name:ADVANCED MEDICAL CENTER PLLC
Entity type:Organization
Organization Name:ADVANCED MEDICAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKONKWO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC, FNP-C
Authorized Official - Phone:336-414-1214
Mailing Address - Street 1:PO BOX 17365
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27116-7365
Mailing Address - Country:US
Mailing Address - Phone:336-331-0978
Mailing Address - Fax:
Practice Address - Street 1:8025 N POINT BLVD STE 140
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3753
Practice Address - Country:US
Practice Address - Phone:336-331-0978
Practice Address - Fax:336-331-0979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty