Healthcare Provider Details

I. General information

NPI: 1982912416
Provider Name (Legal Business Name): TRIUMPH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 MAYFAIR STREET SOUTH SQ 2
DURHAM NC
27707-6226
US

IV. Provider business mailing address

3210 FAIRHILL DR
RALEIGH NC
27612-3215
US

V. Phone/Fax

Practice location:
  • Phone: 919-683-1800
  • Fax: 919-490-5893
Mailing address:
  • Phone: 919-256-0824
  • Fax: 919-256-0833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: HAROLD E JONES JR.
Title or Position: MEMBER MGR/OWNER
Credential:
Phone: 919-256-0824