Organization
TRIUMPH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA FRAZIER (PROVIDER ENROLLMENT SPECIALIST)
(919) 256-0824
Entity
Organization
Contact information
Practice address
3210 FAIRHILL DR, RALEIGH, NC 27612-3220
(919) 256-0824
Mailing address
351 RIVERSIDE DR, SUITE 100, MOUNT AIRY, NC 27030-3850
(336) 783-6919
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5902797
—
NC
Enumeration date
01/25/2007
Last updated
07/24/2007
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