Healthcare Provider Details

I. General information

NPI: 1083631824
Provider Name (Legal Business Name): PAIN AND ORTHOPEDIC NEUROLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3711 LATROBE DR STE 530
CHARLOTTE NC
28211-1664
US

IV. Provider business mailing address

3711 LATROBE DR STE 530
CHARLOTTE NC
28211-1664
US

V. Phone/Fax

Practice location:
  • Phone: 704-365-0966
  • Fax: 704-362-3691
Mailing address:
  • Phone: 704-365-0966
  • Fax: 704-362-3691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number28819
License Number StateNC

VIII. Authorized Official

Name: DR. ANTHONY HALLOCK WHEELER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 704-365-0966