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11635 North Park Drive Wake Forest NC 27587-6526 | |
| (919) 570-6060 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 11635 North Park Drive, Wake Forest, North Carolina |
| Authorized Official Name and Position | Jennifer Roberts (DIRECTOR FINANCE) |
| Authorized Official Contact | 9196840439 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 110566 Durham NC 27709-5566 Ph: (919) 620-4855 | 11635 North Park Drive Wake Forest NC 27587-6526 Ph: (919) 570-6060 |
| NPI Number | 1275561847 |
|---|---|
| Provider Enumeration Date | 06/30/2006 |
| Last Update Date | 08/15/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275561847 | NPI | - | NPPES |
| 0201V | Other | NC | BCBS GROUP NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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