Healthcare Provider Details

I. General information

NPI: 1679908867
Provider Name (Legal Business Name): NEW SMYRNA PAIN & INJURY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 N CAUSEWAY
NEW SMYRNA BEACH FL
32169-5266
US

IV. Provider business mailing address

421 N CAUSEWAY
NEW SMYRNA BEACH FL
32169-5266
US

V. Phone/Fax

Practice location:
  • Phone: 386-900-7246
  • Fax:
Mailing address:
  • Phone: 386-900-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME59641
License Number StateFL

VIII. Authorized Official

Name: HAROLD LAWLER
Title or Position: MEDICAL DOCTOR
Credential:
Phone: 386-690-7246