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901 Old Knight Rd Knightdale NC 27545-9065 | |
(919) 266-6211 | |
(919) 350-9824 |
Full Name | |
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Speciality | Family Medicine |
Location | 901 Old Knight Rd, Knightdale, North Carolina |
Authorized Official Name and Position | Maria Jayoussi (EXECUTIVE DIRECTOR OF FINANCE) |
Authorized Official Contact | 9193506089 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 602195 Charlotte NC 28260-2195 Ph: (919) 350-0554 | 901 Old Knight Rd Knightdale NC 27545-9065 Ph: (919) 266-6211 |
NPI Number | 1225449168 |
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Provider Enumeration Date | 05/14/2014 |
Last Update Date | 08/08/2019 |
Identifier | Type | State | Issuer |
---|---|---|---|
1225449168 | NPI | - | NPPES |
1225449168 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
207R00000X | Internal Medicine | (* (Not Available)) | Secondary |