Organization
WAKEMED SPECIALISTS GROUP, LLC
Active
Other names
WakeMed Childrens Pediatric Minor Procedures
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA JAYOUSSI (EXECUTIVE DIRECTOR OF FINANCE)
(919) 350-6089
Entity
Organization
Contact information
Practice address
3024 NEW BERN AVE, RALEIGH, NC 27610-1247
(919) 350-7846
(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
207LP3000X
Pediatric Anesthesiology Physician
Primary
—
—
Other
Enumeration date
05/01/2019
Last updated
08/19/2019
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