Healthcare Provider Details

I. General information

NPI: 1689878118
Provider Name (Legal Business Name): PAIN AND LASER CENTE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 OWEN DRIVE SUITE 103
FAYETTEVILLE NC
28304-3455
US

IV. Provider business mailing address

PO BOX 40107
FAYETTEVILLE NC
28309-0107
US

V. Phone/Fax

Practice location:
  • Phone: 910-223-7246
  • Fax: 910-223-7247
Mailing address:
  • Phone: 910-223-7246
  • Fax: 910-223-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number200200534
License Number StateNC

VIII. Authorized Official

Name: MICHELLE APPLING
Title or Position: OFFICE MANAGER
Credential:
Phone: 910-223-7246