# PEAK NURITION AND WEIGHT LOSS CLINIC PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942410725
- **Authorized official:** DR. SAMUEL D. BLACKWELL M.D. (OWNER)
- **Authorized official phone:** (919) 367-9355

## Contact information

- **Practice address:** 1011 PEMBERTON HILL RD, SUITE 101, APEX, NC 27502-4266
- **Practice address phone:** (919) 367-9355
- **Practice address fax:** (919) 367-9276
- **Mailing address:** 1011 PEMBERTON HILL RD, SUITE 101, APEX, NC 27502-4266
- **Mailing address phone:** (919) 367-9355
- **Mailing address fax:** (919) 367-9276

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133VN1006X | Metabolic Nutrition Registered Dietitian | L001396 | NC | Yes |
| 207Q00000X | Family Medicine Physician | 32989 | NC | — |

## Other

- **Enumeration date:** 05/23/2007
- **Last updated:** 09/11/2025