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Organization
WAKE SPECIALTY PHYSICIANS LLC
Active
Organization
WAKE SPECIALTY PHYSICIANS LLC
Active
Parent organization
WAKEMED
Other names
WakeMed Physician Practices Group Home
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAKEMED
Authorized official
MARIA JAYOUSSI (EXECUTIVE DIRECTOR OF FINANCE)
(919) 350-6089
Entity
Organization
Contact information
Practice address
2820 KIDD RD, RALEIGH, NC 27610-1842
(919) 350-2800
(919) 350-8147
Mailing address
PO BOX 602195, CHARLOTTE, NC 28260-2195
(919) 350-0552
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942440375
—
NC
Enumeration date
09/22/2016
Last updated
03/22/2017
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