Provider Demographics
NPI:1386976033
Name:FISHER, OLUGBOYEGA REMI
Entity type:Individual
Prefix:MR
First Name:OLUGBOYEGA
Middle Name:REMI
Last Name:FISHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N.TRYON STREET
Mailing Address - Street 2:SUITEB114
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206
Mailing Address - Country:US
Mailing Address - Phone:704-405-4952
Mailing Address - Fax:704-405-4954
Practice Address - Street 1:1801 N.TRYON STREET
Practice Address - Street 2:SUITEB114
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206
Practice Address - Country:US
Practice Address - Phone:704-405-4952
Practice Address - Fax:704-405-4954
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker