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General NPI Number Information
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NPI Number | 1184622334
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Entity Type | Organization
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Legal Business Name | WAKE HEART AND VASCULAR ASSOCIATES P.A.
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2076 NC HIGHWAY 42 W 100
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City | CLAYTON
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State | NC
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Zip | 27520-9226
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Country | US
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Telephone | 919-359-0322
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Fax | 919-359-0326
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Provider Business Mailing Address
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Address Line | 2076 NC HIGHWAY 42 W 100
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City | CLAYTON
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State | NC
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Zip | 27520-9226
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Country | US
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Telephone | 919-359-0322
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Fax | 919-359-0326
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. DEE DARKES
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Credential |
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Telephone | 919-420-1342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | NC
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