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General NPI Number Information
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NPI Number | 1780730895
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Entity Type | Organization
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Legal Business Name | TRIUMPH LLC
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 04/24/2009
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Provider Practice Location Address
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Address Line | 725 N HIGHLAND AVE 2ND FLOOR
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City | WINSTON SALEM
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State | NC
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Zip | 27101-4206
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Country | US
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Telephone | 336-607-8501
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Fax | 336-725-4030
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Provider Business Mailing Address
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Address Line | 3210 FAIRHILL DR
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City | RALEIGH
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State | NC
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Zip | 27612-3215
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Country | US
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Telephone | 919-256-0824
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Fax | 919-256-0833
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Authorized Official
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Title or Position | MEMBER MGR. /OWNER
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Name | HAROLD E JONES
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Credential |
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Telephone | 919-256-0824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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