Healthcare Provider Details

I. General information

NPI: 1790305241
Provider Name (Legal Business Name): CAROLINAS PAIN INSTITUTE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BILLINGSLEY RD STE 210
CHARLOTTE NC
28211-5055
US

IV. Provider business mailing address

145 KIMEL PARK DR STE 330
WINSTON SALEM NC
27103-6972
US

V. Phone/Fax

Practice location:
  • Phone: 336-765-6181
  • Fax: 336-765-8492
Mailing address:
  • Phone: 336-765-6181
  • Fax: 336-765-8492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER AARON GILMORE
Title or Position: TREASURER
Credential: MD
Phone: 336-765-6181