Provider Demographics
NPI:1043622343
Name:UWAGBAI, OMICI (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:OMICI
Middle Name:
Last Name:UWAGBAI
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:OMICI
Other - Middle Name:NIGERIA
Other - Last Name:UWAGBAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:C-1722 TAGATAY DR
Mailing Address - Street 2:
Mailing Address - City:FORT LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-907-8282
Mailing Address - Fax:
Practice Address - Street 1:C-1722 TAGATAY DR
Practice Address - Street 2:
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28310-0003
Practice Address - Country:US
Practice Address - Phone:910-907-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019-00622207QG0300X
VA0101262553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine