| Organization Name: | WAKE SPECIALTY PHYSICIANS, LLC |
| NPI Number: | 1013297365 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARIA JAYOUSSI (EXECUTIVE DIRECTOR) |
| Mailing Address: | 212 Ashville Ave Suite 10 Cary |
| State: | NC US |
| Postal Code: | 275186669 |
| Phone Number: | 9198591136 |
| Fax Number: | 9198594240 |
| NPI Enumeration Date: | 08/18/2011 |
| NPI Last Update Date: | 09/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |