Healthcare Provider Details

I. General information

NPI: 1588937999
Provider Name (Legal Business Name): HEAG PAIN MANAGEMENT CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 POMONA DR
GREENSBORO NC
27407-1619
US

IV. Provider business mailing address

203 POMONA DR
GREENSBORO NC
27407-1619
US

V. Phone/Fax

Practice location:
  • Phone: 336-430-3727
  • Fax:
Mailing address:
  • Phone: 919-220-0107
  • Fax: 336-282-6962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number200500050
License Number StateNC

VIII. Authorized Official

Name: MR. RANDALL NORRIS GRANT
Title or Position: OFFICE MANAGER
Credential:
Phone: 336-609-3801