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General NPI Number Information
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NPI Number | 1073178398
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Entity Type | Organization
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Legal Business Name | WAKEMED SPECIALISTS GROUP LLC
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Dates
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Enumeration Date | 05/02/2019
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Last Update Date | 08/21/2019
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Provider Practice Location Address
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Address Line | 10010 FALLS OF NEUSE RD
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City | RALEIGH
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State | NC
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Zip | 27614-8494
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Country | US
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Telephone | 919-235-6454
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Fax | 919-350-9878
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Provider Business Mailing Address
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Address Line | PO BOX 603949
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City | CHARLOTTE
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State | NC
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Zip | 28260-3949
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Country | US
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Telephone | 919-350-0552
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Fax | 919-350-7687
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR OF FINANCE
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Name | MARIA JAYOUSSI
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Credential |
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Telephone | 919-350-6089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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