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NPI Code Detail

MEDICARE: ADVAITA INTEGRATED MEDICINE PLLC

MEDICARE: ADVAITA INTEGRATED MEDICINE PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician

General Provider Information

NPI Number : 1437727088
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVAITA INTEGRATED MEDICINE PLLC
Provider Business Mailing Address
First Line : 6112 SAINT GILES ST
Second Line :
City : RALEIGH
State : NC
Zip : 27612-7043
Country : US
Telephone Number : 919-893-4465
Fax Number :
Provider Business Practice Location Address
First Line : 6112 SAINT GILES ST
Second Line :
City : RALEIGH
State : NC
Zip : 27612-7043
Country : US
Telephone Number : 919-893-4465
Fax Number :
Authorized Official
Title or Position : CEO
Name : J EULAN JOHNSON III
Credential :
Telephone Number : 828-228-6148
Provider Enumeration Date : 06/10/2021
Last Update Date : 04/01/2026

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