Organization
WAKEMED SPECIALISTS GROUP LLC
Active
Other names
WakeMed Hospitalist Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA JAYOUSSI (EXECUTIVE DIRECTOR OF FINANCE)
(919) 350-6089
Entity
Organization
Contact information
Practice address
2820 KIDD RD, RALEIGH, NC 27610-1842
(919) 350-2800
(919) 350-8147
Mailing address
PO BOX 603949, CHARLOTTE, NC 28260-3949
(919) 350-0552
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255995643
—
NC
Enumeration date
05/01/2019
Last updated
08/13/2019
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