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Organization
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS
Active
Organization
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS
Active
Parent organization
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS
Other names
Marlette Family Practice
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS
Authorized official
MR. LEWIS S THORP III (PRESIDENT CEO)
(336) 721-3900
Entity
Organization
Contact information
Practice address
5175 OLD CLEMMONS SCHOOL ROAD, CLEMMONS, NC 27012
(336) 778-0200
(336) 778-0202
Mailing address
5175 OLD CLEMMONS SCHOOL ROAD, CLEMMONS, NC 27012-9394
(336) 778-0200
(336) 778-0202
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2317728W
MEDICARE GROUP NUMBER
NC
Enumeration date
06/14/2007
Last updated
04/10/2008
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