Organization
WAKE SPECIALTY PHYSICIANS, LLC
Active
Other names
WakeMed Childrens Pediatrics Clayton
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA JAYOUSSI (EXECUTIVE DIRECTOR OF FINANCE)
(919) 350-6089
Entity
Organization
Contact information
Practice address
204 MEDSPRING DR, CLAYTON, NC 27520-9293
(919) 235-6505
(919) 350-8147
Mailing address
PO BOX 602195, CHARLOTTE, NC 28260-2195
(919) 350-0552
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588216253
—
NC
Enumeration date
07/12/2019
Last updated
12/12/2019
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