Healthcare Provider Details

I. General information

NPI: 1578021432
Provider Name (Legal Business Name): AWAKENINGS INFUSION CENTER OF NORTH CAROLINA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2019
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HOLLY SPRINGS RD STE 106
HOLLY SPRINGS NC
27540-6204
US

IV. Provider business mailing address

500 HOLLY SPRINGS RD STE 106
HOLLY SPRINGS NC
27540-6204
US

V. Phone/Fax

Practice location:
  • Phone: 910-514-3558
  • Fax: 919-590-1599
Mailing address:
  • Phone: 919-285-3222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY CHUNG
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 910-514-3558