Wake Diagnostics Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

34D2150941 Issued in NC

Legal business name

WAKE DIAGNOSTICS INC

Practice address

5129 NC 55
Ste 103
Durham, NC 27713

Phone

(919) 399-1215

Fax

(919) 981-9180

NPI assigned

Jun 12, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Goverdhan Reddy Vavilala, PHD

Title

Ceo

Phone

(919) 462-1494

Specialties & licenses 1

Addresses

Other names 1

• Wake Diagnostics Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757635200000",
    "number": "1073006144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5129 NC 55",
            "address_2": "STE 103",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "27713",
            "telephone_number": "919-399-1215",
            "fax_number": "919-981-9180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5129 NC 55",
            "address_2": "STE 103",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "27713",
            "telephone_number": "919-399-1215",
            "fax_number": "919-981-9180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE DIAGNOSTICS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-12",
        "last_updated": "2025-09-12",
        "certification_date": "2023-05-09",
        "status": "A",
        "authorized_official_last_name": "VAVILALA",
        "authorized_official_first_name": "GOVERDHAN",
        "authorized_official_middle_name": "REDDY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "919-462-1494",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NC",
            "license": "34D2150941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wake Diagnostics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Selbourne Waite
• Selena Waite, LPA, LCMHC, HSP-PA
• Anna Waites
• Lauren Ann Waits
• Wake Counseling Associates, PLLC
• Wake Specialty Physicians LLC
• Wake Specialty Physicians LLC
• Jeffrey Harrison Wakefield, PT, DPT, ATC
• Susan Wakil, M.D.
• Wal-Mart Stores East LP

• Clinical Medical Laboratory in Durham, NC
• Providers in Durham, NC by specialty
• Clinical Medical Laboratory in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.