MEDICARE: ADDICTION MEDICINE PARTNERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1629879127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADDICTION MEDICINE PARTNERS

Provider Business Mailing Address
First Line	:	4601 LAKE BOONE TRL STE 3A
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-7518
Country	:	US
Telephone Number	:	919-205-9848
Fax Number	:

Provider Business Practice Location Address
First Line	:	4601 LAKE BOONE TRL STE 3A
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-7518
Country	:	US
Telephone Number	:	919-205-9848
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROBYN JORDAN
Credential	:	MD
Telephone Number	:	919-205-9848

Provider Enumeration Date	:	03/20/2025
Last Update Date	:	05/26/2026

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