Healthcare Provider Details

I. General information

NPI: 1609268689
Provider Name (Legal Business Name): FACIALS & FILLERS AESTHETICS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2015
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5056 HWY 70 W SUITE A
MOREHEAD CITY NC
28557-4502
US

IV. Provider business mailing address

5056 HWY 70 W SUITE A
MOREHEAD CITY NC
28557-4502
US

V. Phone/Fax

Practice location:
  • Phone: 252-240-3223
  • Fax: 252-499-9004
Mailing address:
  • Phone: 252-240-3223
  • Fax: 252-499-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number24073
License Number StateNC

VIII. Authorized Official

Name: DR. WILLIAM JAMES HALL JR.
Title or Position: PHYSICIAN OWNER
Credential: M.D.
Phone: 252-240-3223