Healthcare Provider Details

I. General information

NPI: 1265341127
Provider Name (Legal Business Name): BRAHEEM ABDIL WARD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6436 CORAL VINE WAY
WHITSETT NC
27377-9326
US

IV. Provider business mailing address

6436 CORAL VINE WAY
WHITSETT NC
27377-9326
US

V. Phone/Fax

Practice location:
  • Phone: 919-448-7919
  • Fax:
Mailing address:
  • Phone: 919-448-7919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number261Q00000X
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: