Provider Demographics
NPI:1538652557
Name:AMN MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:AMN MEDICAL GROUP PLLC
Other - Org Name:WAKE HEALTH MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:NADOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-554-6754
Mailing Address - Street 1:13200 FALLS OF NEUSE RD STE 113
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8269
Mailing Address - Country:US
Mailing Address - Phone:919-554-6754
Mailing Address - Fax:
Practice Address - Street 1:13200 FALLS OF NEUSE RD STE 113
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614
Practice Address - Country:US
Practice Address - Phone:919-554-6754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-13
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-02254208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty