Provider Demographics
NPI:1508830845
Name:VILLAGE FAMILY CARE OF WAKE FOREST PA
Entity Type:Organization
Organization Name:VILLAGE FAMILY CARE OF WAKE FOREST PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CARSON
Authorized Official - Last Name:ROUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-562-2288
Mailing Address - Street 1:PO BOX 2060
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27588
Mailing Address - Country:US
Mailing Address - Phone:919-562-2288
Mailing Address - Fax:919-562-2225
Practice Address - Street 1:110 CAPCOM AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587
Practice Address - Country:US
Practice Address - Phone:919-562-2288
Practice Address - Fax:919-562-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC85326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty