# WAKE SPECIALTY PHYSICIANS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WAKEMED PRIMARY CARE KILDAIRE FARM ROAD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871052597
- **Authorized official:** MARIA JAYOUSSI (EXECUTIVE DIRECTOR OF FINANCE)
- **Authorized official phone:** (919) 350-6089

## Contact information

- **Practice address:** 222 ASHVILLE AVE, CARY, NC 27518-6130
- **Practice address phone:** (919) 350-6575
- **Practice address fax:** (919) 235-6598
- **Mailing address:** PO BOX 602195, CHARLOTTE, NC 28260-2195
- **Mailing address phone:** (919) 350-0552
- **Mailing address fax:** (919) 350-7687

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 03/13/2019
- **Last updated:** 08/08/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1871052597 | — | NC |