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General NPI Number Information
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NPI Number | 1659947117
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Entity Type | Organization
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Legal Business Name | CENTERS FOR ADVANCED UROLOGY, LLC
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Dates
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Enumeration Date | 06/03/2021
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 1904 S MAIN ST STE 114
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City | WAKE FOREST
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State | NC
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Zip | 27587-5030
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Country | US
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Telephone | 919-390-3978
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Fax |
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Provider Business Mailing Address
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Address Line | 1904 S MAIN ST STE 114
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City | WAKE FOREST
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State | NC
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Zip | 27587-5030
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING AGENT
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Name | JOANIE MARIE COCHRAN
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Credential |
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Telephone | 336-306-9755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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