Provider Demographics
NPI:1013571587
Name:WAKEMED SPECIALISTS GROUP, LLC
Entity Type:Organization
Organization Name:WAKEMED SPECIALISTS GROUP, LLC
Other - Org Name:WAKEMED BARIATRICS SURGERY & MEDICAL WEIGHT LOSS
Other - Org Type:Other Name
Authorized Official - Title/Position:VP, WPP
Authorized Official - Prefix:MS
Authorized Official - First Name:SHONDRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BRINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-350-6045
Mailing Address - Street 1:2920 HIGHWOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-0010
Mailing Address - Country:US
Mailing Address - Phone:919-350-0554
Mailing Address - Fax:919-350-7687
Practice Address - Street 1:160 MACGREGOR PINES DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6036
Practice Address - Country:US
Practice Address - Phone:919-234-4468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Multi-Specialty