Healthcare Provider Details

I. General information

NPI: 1629223409
Provider Name (Legal Business Name): JAMES A WAINER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 DRESSER CT STE 103
RALEIGH NC
27609-7325
US

IV. Provider business mailing address

867 WASHINGTON ST
RALEIGH NC
27605-1255
US

V. Phone/Fax

Practice location:
  • Phone: 919-831-5249
  • Fax: 919-790-1521
Mailing address:
  • Phone: 919-833-5869
  • Fax: 919-833-5859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number31754
License Number StateNC

VIII. Authorized Official

Name: DR. JAMES A WAINER
Title or Position: PRESIDENT
Credential: MD
Phone: 919-831-5249