Wake Specialty Physicians
Family Medicine in Wake Forest, NC. Organization (NPI-2).
NPI number1346852407
StatusActive
Last updated in NPPESJan 5, 2022
Details
- NPI
- 1346852407
- Entity type
- Organization (NPI-2)
- Legal business name
- Wake Specialty Physicians
- Organization subpart
- No
- Enumeration date
- Aug 20, 2020
- Certification date
- Jan 5, 2022
- Last updated
- Jan 5, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
| 207R00000X | Internal Medicine | – | – |
Other names
- Wakemed Mycare 365 Primary & Urgent Care Wake Forest (Doing Business As)
Practice location
2001 S Main St Ste 200Wake Forest, NC 27587-1652
Phone 919-235-6540 · Fax 919-235-6504
Mailing address
2001 S Main St Ste 200Wake Forest, NC 27587-1652
Phone 919-235-6540 · Fax 919-235-6504
Authorized official
Shondra Lynn Brink
Vp Operations
9193506045
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