Healthcare Provider Details

I. General information

NPI: 1538235494
Provider Name (Legal Business Name): EASTERN CAROLINA PAIN MANAGEMENT CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 VALLEYGATE DR SUITE 201
FAYETTEVILLE NC
28304-3688
US

IV. Provider business mailing address

PO BOX 3426
WILMINGTON NC
28406-0426
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-8454
  • Fax: 910-321-0656
Mailing address:
  • Phone: 910-251-8474
  • Fax: 910-251-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number35361
License Number StateNC

VIII. Authorized Official

Name: DR. TONI HARRIS
Title or Position: PHYSICIAN DIRECTOR
Credential: MD
Phone: 910-251-8474