Healthcare Provider Details

I. General information

NPI: 1174625248
Provider Name (Legal Business Name): HEAG PAIN MANAGEMENT CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
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: 919-220-0107
  • Fax: 919-220-7623
Mailing address:
  • Phone: 919-220-0107
  • Fax: 919-220-7623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
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: 336-282-0132