Healthcare Provider Details

I. General information

NPI: 1730875444
Provider Name (Legal Business Name): GVNR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 E MULBERRY ST
GOLDSBORO NC
27530-3733
US

IV. Provider business mailing address

206 E MULBERRY ST
GOLDSBORO NC
27530-3733
US

V. Phone/Fax

Practice location:
  • Phone: 919-394-9727
  • Fax: 919-759-9188
Mailing address:
  • Phone: 919-394-9727
  • Fax: 919-759-9188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MATHEW WILDING
Title or Position: OWNER
Credential: DC
Phone: 919-394-9727