Wake Forest Health Network LLC

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

Legal business name

WAKE FOREST HEALTH NETWORK LLC

Practice address

1002 N Church St Ste 203
Greensboro, NC 27401-1448

Phone

(336) 907-7980

NPI assigned

Apr 11, 2013

Organization subpart

No

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

Authorized official

Name

Craig Michael Greven, MD

Title

Sr VP Clinical Operations

Phone

(336) 716-1331

Specialties & licenses 1

Addresses

Other names 1

• Atrium Health Wake Forest Baptist Bowers Plastic Surgery - Greensboro Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Julie S Gupton, PA-C

  • Medical Physician Assistant
  • King, NC
  • NPI 1952715245
  NPD
• Mishi Kavon Jackson, MD

  • Family Medicine Physician
  • Kernersville, NC
  • NPI 1215006192
  NPD
• Davette Traci Williams, RN

  • Nurse Practitioner
  • Kernersville, NC
  • NPI 1265727192
  NPD

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

{
    "created_epoch": "1365638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758758400000",
    "number": "1922441773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 N CHURCH ST STE 203",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274011448",
            "telephone_number": "336-907-7980",
            "fax_number": "336-907-7987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 N CHURCH ST STE 203",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274011448",
            "telephone_number": "336-907-7980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE FOREST HEALTH NETWORK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-11",
        "last_updated": "2025-09-25",
        "certification_date": "2025-09-25",
        "status": "A",
        "authorized_official_last_name": "GREVEN",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "SR VP CLINICAL OPERATIONS",
        "authorized_official_telephone_number": "336-716-1331",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd Ste B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Atrium Health Wake Forest Baptist Bowers Plastic Surgery - Greensboro",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wake Forest Baptist Imaging LLC
• Wake Forest Emergency Providers
• Wake Forest Health Network LLC
• Wake Forest Health Network LLC
• Wake Forest Health Network LLC
• Wake Forest Health Network, LLC
• Wake Forest Health Network, LLC
• Wake Forest University Health Sciences
• Wake Forest University Health Sciences
• Wake Forest University Health Sciences

• All providers in Greensboro, NC
• Plastic and Reconstructive Surgery Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 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.