Healthcare Provider Details

I. General information

NPI: 1275658692
Provider Name (Legal Business Name): WAKE FOREST HEALTH NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 PHILLIPS AVE
HIGH POINT NC
27262-7075
US

IV. Provider business mailing address

905 PHILLIPS AVE
HIGH POINT NC
27262-7075
US

V. Phone/Fax

Practice location:
  • Phone: 336-802-2040
  • Fax: 336-802-2041
Mailing address:
  • Phone: 336-802-2040
  • Fax: 336-802-2041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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