Healthcare Provider Details

I. General information

NPI: 1073647590
Provider Name (Legal Business Name): HEAG PAIN MANAGEMENT CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 BATTLEGROUND AVE
GREENSBORO NC
27408-2704
US

IV. Provider business mailing address

2800 BATTLEGROUND AVE
GREENSBORO NC
27408-2704
US

V. Phone/Fax

Practice location:
  • Phone: 336-282-0132
  • Fax: 336-282-6962
Mailing address:
  • Phone: 336-282-0132
  • Fax: 336-282-6962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number200500050
License Number StateNC

VIII. Authorized Official

Name: KWADWO GYARTENG-DAKWA
Title or Position: MANAGER
Credential:
Phone: 919-220-0107