| Live Well Primary Care | |
|
4822 Six Forks Rd Ste 104 Raleigh NC 27609-5269 | |
| (919) 618-5772 | |
| Not Available |
| Full Name | Live Well Primary Care |
|---|---|
| Speciality | Family Medicine |
| Location | 4822 Six Forks Rd Ste 104, Raleigh, North Carolina |
| Authorized Official Name and Position | Datanya Yvetts Betts (CEO) |
| Authorized Official Contact | 9196185772 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Live Well Primary Care 4822 Six Forks Rd Ste 104 Raleigh NC 27609-5269 Ph: (919) 618-5772 | Live Well Primary Care 4822 Six Forks Rd Ste 104 Raleigh NC 27609-5269 Ph: (919) 618-5772 |
| NPI Number | 1952811267 |
|---|---|
| Provider Enumeration Date | 10/02/2017 |
| Last Update Date | 10/02/2017 |
| Medicare PECOS PAC ID | 1052673076 |
|---|---|
| Medicare Enrollment ID | O20180402001491 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952811267 | NPI | - | NPPES |
| 1639501539 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 5006305 (North Carolina) | Primary |
| Provider Name | Datanya Y Betts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639501539 PECOS PAC ID: 1951532092 Enrollment ID: I20140402002003 |
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