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Organization
WAKE SPECIALTY PHYSICIANS LLC
Active
Organization
WAKE SPECIALTY PHYSICIANS LLC
Active
Other names
WakeMed Primary Care Downtown Raleigh
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA JAYOUSSI (EXECUTIVE DIRECTOR OF FINANCE)
(919) 350-6089
Entity
Organization
Contact information
Practice address
150 E DAVIE ST, RALEIGH, NC 27601-1806
(919) 834-5299
(919) 350-9820
Mailing address
PO BOX 602195, CHARLOTTE, NC 28260-2195
(919) 350-0554
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699186619
—
NC
Enumeration date
05/13/2014
Last updated
08/08/2019
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