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Raleigh Durham Medical Group PA — NPI 1164865416, Clayton, NC | NPI Central

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NPI 1164865416

OrganizationActive

Raleigh Durham Medical Group PA

NPI 1164865416 · Non-Pharmacy Dispensing Site · Clayton, NC

Provider details

NPI number: 1164865416
Entity type: Organization
Primary specialty: Non-Pharmacy Dispensing SiteSuppliers
Parent organization: Medvantx, Inc.
Organization subpart: Yes
Authorized official: Kenny Heine, Vp of Operations(858) 964-1506
License: 200400430 (NC)

Specialties & taxonomies

Non-Pharmacy Dispensing SitePrimary332900000XLicense 200400430 (NC)
Suppliers

Practice location

2076 Highway 42 West

Suite 230

Clayton, NC 27520

Phone: (919) 553-5711

Approximate (ZIP-level) locationGet directions

More NC providers

Mailing address

5626 Oberlin Dr

San Diego, CA 92121-1705

Other names (DBA / former)

Doing business as: Family Wellness Clinic

Registry dates

Enumerated: 2013-04-16
Last updated: 2013-04-16

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.