Organization
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS
Active
Parent organization
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS
Other names
Mocksville Pediatrics
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS
Authorized official
MR. LEWIS S THORP III (PRESIDENT CEO)
(336) 721-3900
Entity
Organization
Contact information
Practice address
113 MARKETPLACE DRIVE, MOCKSVILLE, NC 27028
(336) 753-8244
(336) 753-8248
Mailing address
113 MARKETPLACE DRIVE, MOCKSVILLE, NC 27028
(336) 753-8244
(336) 753-8248
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2317728R
MEDICARE GROUP NUMBER
NC
05
—
89015YH
—
NC
Enumeration date
08/23/2005
Last updated
04/10/2008
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