Organization
WAKE FAMILY MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MRINALINI SUJALA KODUMAGULLA MD (OWNER/PHYSICAN)
(919) 395-3491
Entity
Organization
Contact information
Practice address
1831 LAKE PINE DR STE 200, CARY, NC 27511-6050
(919) 380-1849
(919) 380-1851
Mailing address
1831 LAKE PINE DR STE 200, CARY, NC 27511-6050
(919) 380-1849
(919) 380-1851
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
05/18/2009
Last updated
09/30/2019
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