Organization
WAKE FOREST HEALTH NETWORK LLC
Active
Other names
Atrium Health Wake Forest Baptist Pediatrics - Ford Simpson Lively & R
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG MICHAEL GREVEN MD (SR VP CLINICAL OPERATIONS)
(336) 716-1331
Entity
Organization
Contact information
Practice address
2933 MAPLEWOOD AVE, WINSTON SALEM, NC 27103-4009
(336) 794-3380
(336) 794-3378
Mailing address
2933 MAPLEWOOD AVE STE 1, WINSTON SALEM, NC 27103-4001
(336) 794-3380
(336) 794-3378
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5909124
—
NC
05
—
5950112
—
NC
05
—
5950113
—
NC
Enumeration date
05/15/2009
Last updated
09/25/2025
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