Healthcare Provider Details

I. General information

NPI: 1215580790
Provider Name (Legal Business Name): P.DION BEAUTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 OLD MONROE RD
INDIAN TRAIL NC
28079-5352
US

IV. Provider business mailing address

6601 OLD MONROE RD
INDIAN TRAIL NC
28079-5352
US

V. Phone/Fax

Practice location:
  • Phone: 980-858-9053
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name: PEBBLES GRIFFIN-DOCKERY
Title or Position: MANAGER
Credential:
Phone: 704-906-2498