Provider Demographics
NPI:1306260021
Name:SOL MEDICAL GROUP PLLC
Entity type:Organization
Organization Name:SOL MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNNIYI
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:919-883-2108
Mailing Address - Street 1:401 WAIT AVE
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-2725
Mailing Address - Country:US
Mailing Address - Phone:919-883-2108
Mailing Address - Fax:
Practice Address - Street 1:401 WAIT AVE
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587
Practice Address - Country:US
Practice Address - Phone:919-883-2108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
NC198788208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty