Organization
WAKEMED SPECIALISTS GROUP, LLC
Active
Other names
WakeMed Childrens Pediatric Pulmonology
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA JAYOUSSI (EXECUTIVE DIRECTOR OF FINANCE)
(919) 350-6089
Entity
Organization
Contact information
Practice address
104 MEDSPRING DR, CLAYTON, NC 27520-9687
(919) 235-6535
Mailing address
PO BOX 603949, CHARLOTTE, NC 28260-3949
(919) 350-0554
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
2080P0214X
Pediatric Pulmonology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407409543
—
NC
Enumeration date
07/18/2019
Last updated
02/06/2020
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