Heritage Internal Medicine, PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

200701946 Issued in NC

Legal business name

HERITAGE INTERNAL MEDICINE, PLLC

Practice address

2824 Rogers Rd
Suite 100
Wake Forest, NC 27587-3895

Phone

(919) 435-0380

NPI assigned

Nov 16, 2011

Last updated

Nov 16, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Sol Jimenez Gazzingan, M.D.

Title

Manager

Phone

(919) 435-0380

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Heather Johnson Lawson, MSN, RN, FNP-C

  • Family Nurse Practitioner
  • Raleigh, NC
  • NPI 1649757113
  NPD
• Emily Lamb Viva, LCSW

  • Clinical Social Worker
  • Raleigh, NC
  • NPI 1891175055
  NPD

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

{
    "created_epoch": "1321401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321401600000",
    "number": "1457638645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 HIDDEN LAKE DR",
            "city": "YOUNGSVILLE",
            "state": "NC",
            "postal_code": "275967471",
            "telephone_number": "919-435-0380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2824 ROGERS RD",
            "address_2": "SUITE 100",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275873895",
            "telephone_number": "919-435-0380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE INTERNAL MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-16",
        "last_updated": "2011-11-16",
        "status": "A",
        "authorized_official_last_name": "GAZZINGAN",
        "authorized_official_first_name": "SOL",
        "authorized_official_middle_name": "JIMENEZ",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "919-435-0380",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NC",
            "license": "200701946",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5912424",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Henry, DPT
• Her Psychiatry Wellness
• Heritage Audiology, PLLC
• Heritage Counseling Services Inc.
• Heritage Eye Care, Inc
• Heritage Wound Management Specialists PLLC
• Guadalupe Hernandez Mancilla
• Trinity Herring
• Hope Hickman, LCMHCA, NCC
• Dylan Elyse Hicks

• Specialist in Wake Forest, NC
• Providers in Wake Forest, NC by specialty
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.