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Organization
WAKEMED SPECIALISTS GROUP, LLC
Active
Organization
WAKEMED SPECIALISTS GROUP, LLC
Active
Other names
WakeMed Childrens Pediatric Weight Management
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA JAYOUSSI (EXECUTIVE DIRECTOR OF FINANCE)
(919) 350-6089
Entity
Organization
Contact information
Practice address
23 SUNNYBROOK RD, RALEIGH, NC 27610-1855
(919) 235-6439
(919) 231-0314
Mailing address
PO BOX 603949, CHARLOTTE, NC 28260-3949
(919) 350-0552
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
2080B0002X
Pediatric Obesity Medicine Physician
Primary
—
NULL
2080B0002X
Pediatric Obesity Medicine Physician
Primary
—
—
Other
Enumeration date
05/01/2019
Last updated
08/19/2019
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