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General NPI Number Information
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NPI Number | 1861564924
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Entity Type | Organization
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Legal Business Name | WAKELON INTERNAL MEDICINE PLLC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 09/04/2007
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Provider Practice Location Address
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Address Line | 301 HOSPITAL ROAD
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City | ZEBULON
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State | NC
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Zip | 27597
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Country | US
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Telephone | 919-269-0390
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Fax | 919-269-6868
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Provider Business Mailing Address
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Address Line | 301 HOSPITAL ROAD
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City | ZEBULON
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State | NC
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Zip | 27597
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Country | US
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Telephone | 919-269-0390
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Fax | 919-269-6868
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Authorized Official
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Title or Position | MD
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Name | MS. SHELLY LORRAINE WEST
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Credential | MD
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Telephone | 919-269-0390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 200001025
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License Number State | NC
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