Provider Demographics
NPI:1184209470
Name:CEDAR OAKS CLINIC PLLC
Entity Type:Organization
Organization Name:CEDAR OAKS CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC
Authorized Official - Prefix:
Authorized Official - First Name:CEDAR OAKS
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-529-5920
Mailing Address - Street 1:1748 HERITAGE CENTER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-9855
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1748 HERITAGE CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-9855
Practice Address - Country:US
Practice Address - Phone:919-332-8969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty