Provider Demographics
NPI:1467866152
Name:TRIANGLE WELLNESS PLLC
Entity Type:Organization
Organization Name:TRIANGLE WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-210-1874
Mailing Address - Street 1:570 NEW WAVERLY PL
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7405
Mailing Address - Country:US
Mailing Address - Phone:919-210-1874
Mailing Address - Fax:
Practice Address - Street 1:530 NEW WAVERLY PL
Practice Address - Street 2:SUITE 301
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7414
Practice Address - Country:US
Practice Address - Phone:919-210-1874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36499207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty