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General NPI Number Information
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NPI Number | 1467866152
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Entity Type | Organization
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Legal Business Name | TRIANGLE WELLNESS PLLC
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Dates
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Enumeration Date | 06/20/2014
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Last Update Date | 12/03/2014
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Provider Practice Location Address
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Address Line | 530 NEW WAVERLY PL SUITE 301
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City | CARY
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State | NC
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Zip | 27518-7414
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Country | US
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Telephone | 919-210-1874
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Fax |
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Provider Business Mailing Address
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Address Line | 570 NEW WAVERLY PL SUITE 130
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City | CARY
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State | NC
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Zip | 27518-7405
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Country | US
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Telephone | 919-210-1874
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Fax |
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Authorized Official
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Title or Position | SOLE MBR
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Name | DR. GREGORY BRANNON
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Credential | M.D.
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Telephone | 919-210-1874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 36499
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License Number State | NC
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