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10500 Ligon Mill Rd Suite 113 Wake Forest NC 27587-4576 | |
| (919) 570-5705 | |
| (919) 570-5710 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 10500 Ligon Mill Rd, Wake Forest, North Carolina |
| Authorized Official Name and Position | Leea Jeanine Walton (RCS MANAGER) |
| Authorized Official Contact | 7043166081 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 60447 Charlotte NC 28260-0447 Ph: (919) 570-5705 | 10500 Ligon Mill Rd Suite 113 Wake Forest NC 27587-4576 Ph: (919) 570-5705 |
| NPI Number | 1235458985 |
|---|---|
| Provider Enumeration Date | 05/20/2010 |
| Last Update Date | 07/09/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235458985 | NPI | - | NPPES |
| 5914970 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 2005-01578 (North Carolina) | Primary |
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