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Organization
WAKE PRIMARY CARE, PLLC
Active
Organization
WAKE PRIMARY CARE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN SMITH CREDENTIAL (CREDENTIALING COORDINATOR)
(919) 342-6842
Entity
Organization
Contact information
Practice address
400 ASHVILLE AVE, SUITE 315, CARY, NC 27518-6134
(919) 803-3316
(919) 803-3354
Mailing address
408 COLE CREST CT, CARY, NC 27513-8374
(919) 803-3316
(919) 803-3354
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2011-01123
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5917977
—
NC
Enumeration date
10/10/2013
Last updated
10/10/2013
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