Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Domonique Battle Koomson

Individual provider Physician Assistant · NPI 1194479683

Domonique Battle Koomson is a Physician Assistant in Fayetteville, North Carolina. Qualified in 2021, 5 years ago. Practices with North Carolina Mg LLC, a 712-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
5
Licensed in
NC
In the registry since
2022
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Practice location Address checks out

3637 Cape Center Dr
Fayetteville, NC 28304-4457
Phone: (910) 491-1760
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 4420 Lake Boone Trl, Raleigh, NC 27607-7505 — (919) 784-3542

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 0010-12110 (NC)

Record details

NPI number1194479683
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedFebruary 4, 2022
Last updated in NPPESJanuary 20, 2023
Certification dateJanuary 20, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice North Carolina Mg Llc — 712 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Fayetteville