Provider Demographics
NPI:1700490232
Name:WAKE FOREST BAPTIST IMAGING, LLC
Entity Type:Organization
Organization Name:WAKE FOREST BAPTIST IMAGING, LLC
Other - Org Name:ATRIUM HEALTH WAKE FOREST BAPTIST IMAGING FRIENDLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/CHIEF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CANNON
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-550-6044
Mailing Address - Street 1:800 CRESCENT CENTRE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7270
Mailing Address - Country:US
Mailing Address - Phone:615-261-2306
Mailing Address - Fax:855-588-3545
Practice Address - Street 1:861 OLD WINSTON RD STE 105
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-7141
Practice Address - Country:US
Practice Address - Phone:336-765-5722
Practice Address - Fax:336-765-5723
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAKE FOREST BAPTIST IMAGING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-02
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty