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Organization
WAKE SPECIALTY PHYSICIANS, LLC
Active
Organization
WAKE SPECIALTY PHYSICIANS, LLC
Active
Other names
WAKEMED TRANSITIONAL HEALTH
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA JAYOUSSI (EXECUTIVE DIRECTOR)
(919) 350-0552
Entity
Organization
Contact information
Practice address
3024 NEW BERN AVE, RALEIGH, NC 27610-1247
(919) 350-7859
(919) 350-7204
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
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942440375
—
NC
Enumeration date
06/19/2014
Last updated
03/01/2017
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