Healthcare Provider Details

I. General information

NPI: 1619484649
Provider Name (Legal Business Name): PAIN AND WELLNESS SOLUTIONS OF THE CAROLINAS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5322 HIGHGATE DR STE 143
DURHAM NC
27713-6633
US

IV. Provider business mailing address

5322 HIGHGATE DR STE 143
DURHAM NC
27713-6633
US

V. Phone/Fax

Practice location:
  • Phone: 984-464-7972
  • Fax:
Mailing address:
  • Phone: 984-464-7972
  • Fax: 919-591-0567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number2009-00892
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number2009-00892
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2009-00892
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number2009-00892
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number2009-00892
License Number StateNC

VIII. Authorized Official

Name: DR. MANOJ BOBBY SUBBARAO WUNNAVA
Title or Position: PHYSICIAN
Credential: MD
Phone: 984-464-7972