Provider Demographics
NPI:1154559839
Name:SANDHILLS MEDICAL CARE CENTER, PLLC
Entity type:Organization
Organization Name:SANDHILLS MEDICAL CARE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GODFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FONDINKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-424-6553
Mailing Address - Street 1:4155 FERNCREEK DR
Mailing Address - Street 2:SUITE 102B
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2581
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4155 FERNCREEK DR
Practice Address - Street 2:SUITE 102B
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2581
Practice Address - Country:US
Practice Address - Phone:910-424-6553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center