Provider Demographics
NPI:1609133693
Name:AVAYA HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:AVAYA HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:919-454-1672
Mailing Address - Street 1:6409 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE 120-302
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6297
Mailing Address - Country:US
Mailing Address - Phone:919-454-1672
Mailing Address - Fax:919-381-4910
Practice Address - Street 1:6409 FAYETTEVILLE RD
Practice Address - Street 2:SUITE 120-302
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6297
Practice Address - Country:US
Practice Address - Phone:919-454-1672
Practice Address - Fax:919-381-4910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization