Provider Demographics
NPI:1487360426
Name:AKINWUNTAN, OLUGBENGA FRANCIS
Entity type:Individual
Prefix:
First Name:OLUGBENGA
Middle Name:FRANCIS
Last Name:AKINWUNTAN
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1035 LINCOLNTON RD STE E
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-6277
Practice Address - Country:US
Practice Address - Phone:704-637-1123
Practice Address - Fax:704-637-1214
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF10220574363L00000X
NC5018014363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1710933692Medicaid