Healthcare Provider Details

I. General information

NPI: 1891997334
Provider Name (Legal Business Name): EAST CAROLINA PSYCHIATRIC CONSULTANTS,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 ELEVENTH ST
GOLDSBORO NC
27534-1616
US

IV. Provider business mailing address

916 ELEVENTH ST
GOLDSBORO NC
27534-1616
US

V. Phone/Fax

Practice location:
  • Phone: 919-735-9119
  • Fax: 919-735-9120
Mailing address:
  • Phone: 919-735-9119
  • Fax: 919-735-9120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number31639
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number31639
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number31639
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number31639
License Number StateNC

VIII. Authorized Official

Name: MUTHIAH K. SABANAYAGAM
Title or Position: OWNER
Credential: M.D.
Phone: 919-735-9119