Provider Demographics
NPI:1316344195
Name:FAMILY FIRST MEDICAL CENTER, PLLC
Entity type:Organization
Organization Name:FAMILY FIRST MEDICAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:NKASIOBI
Authorized Official - Last Name:NWAUCHE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:704-575-5064
Mailing Address - Street 1:424 RUNNING HORSE LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7232
Mailing Address - Country:US
Mailing Address - Phone:704-575-5064
Mailing Address - Fax:704-243-7506
Practice Address - Street 1:4822 ALBEMARLE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6668
Practice Address - Country:US
Practice Address - Phone:704-575-5064
Practice Address - Fax:704-243-7506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-22
Last Update Date:2014-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006397261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care