Healthcare Provider Details

I. General information

NPI: 1063556728
Provider Name (Legal Business Name): DOUGLAS DUSSEL PRITCHARD MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 SIGNAL HILL DRIVE EXT SUITE 100
STATESVILLE NC
28625-4337
US

IV. Provider business mailing address

610 SIGNAL HILL DRIVE EXT SUITE 100
STATESVILLE NC
28625-4337
US

V. Phone/Fax

Practice location:
  • Phone: 704-818-0480
  • Fax: 704-818-0490
Mailing address:
  • Phone: 704-818-0480
  • Fax: 704-818-0490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number18045
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number10845
License Number StateNC

VIII. Authorized Official

Name: DR. DOUGLAS DUSSEL PRITCHARD
Title or Position: OWNER
Credential: M.D.
Phone: 704-818-0840