Healthcare Provider Details

I. General information

NPI: 1811233075
Provider Name (Legal Business Name): WAKE FOREST HEALTH NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COMER ST
DOBSON NC
27017-8804
US

IV. Provider business mailing address

111 COMER ST
DOBSON NC
27017-8804
US

V. Phone/Fax

Practice location:
  • Phone: 336-386-4452
  • Fax: 336-386-4569
Mailing address:
  • Phone: 336-386-4452
  • Fax: 336-386-4569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CRAIG MICHAEL GREVEN
Title or Position: SR VP CLINICAL OPERATIONS
Credential: MD
Phone: 336-716-1331