Healthcare Provider Details

I. General information

NPI: 1952642142
Provider Name (Legal Business Name): TRIANGLE WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7940 WILLIAMS POND LN 150
CHARLOTTE NC
28277-8766
US

IV. Provider business mailing address

530 NEW WAVERLY PL SUITE 301
CARY NC
27518-7414
US

V. Phone/Fax

Practice location:
  • Phone: 704-752-7779
  • Fax: 704-752-7775
Mailing address:
  • Phone: 919-851-3480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VB0002X
TaxonomyObesity Medicine (Obstetrics & Gynecology) Physician
License Number36499
License Number StateNC

VIII. Authorized Official

Name: DR. GREGORY BRANNON
Title or Position: MEMBER, MEDICAL DIRECTOR
Credential: M.D.
Phone: 919-851-3480