Organization
WAKE SPECIALTY PHYSICIANS LLC
Active
Other names
Cary Breast Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA JAYOUSSI (EXEC. VP OF FINANCE)
(919) 350-0554
Entity
Organization
Contact information
Practice address
530 NEW WAVERLY PL, CARY, NC 27518-7414
(919) 350-2300
(919) 350-7687
Mailing address
PO BOX 602195, CHARLOTTE, NC 28260-2195
(919) 350-0552
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942440375
—
NC
Enumeration date
12/10/2018
Last updated
12/10/2018
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