Healthcare Provider Details

I. General information

NPI: 1669511143
Provider Name (Legal Business Name): GOLDSBORO PAIN MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 PARKWAY DR STE C
GOLDSBORO NC
27534-9432
US

IV. Provider business mailing address

1208 PARKWAY DR STE C
GOLDSBORO NC
27534-9432
US

V. Phone/Fax

Practice location:
  • Phone: 919-751-8444
  • Fax: 919-751-0890
Mailing address:
  • Phone: 919-751-8444
  • Fax: 919-751-0890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number107402
License Number StateNC

VIII. Authorized Official

Name: DR. RONALD MORGAN LONG
Title or Position: OWNER
Credential: M.D.
Phone: 919-751-8444