Basic Information
| Provider Information | |||||||||
| NPI: | 1073800041 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAM | ||||||||
| FirstName: | ABIGAIL | ||||||||
| MiddleName: | AKOMAH-GYAMFI | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | AKOMAH-GYAMFI | ||||||||
| OtherFirstName: | ABIGAIL | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 405 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | RAEFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283763222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106155800 | ||||||||
| FaxNumber: | 9108750309 | ||||||||
| Practice Location | |||||||||
| Address1: | 405 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | RAEFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283763222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106155800 | ||||||||
| FaxNumber: | 9108750309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2011 | ||||||||
| LastUpdateDate: | 05/03/2016 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2014-01897 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.