Healthcare Provider Details

I. General information

NPI: 1902722390
Provider Name (Legal Business Name): NORTH CAROLINA INTERVENTIONAL PAIN - B, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PINER RD STE 120A
WILMINGTON NC
28409-4203
US

IV. Provider business mailing address

455 PHILIP BLVD STE 140
LAWRENCEVILLE GA
30046-8768
US

V. Phone/Fax

Practice location:
  • Phone: 770-962-3642
  • Fax:
Mailing address:
  • Phone: 770-962-3642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMIT PATEL
Title or Position: CEO
Credential: MD
Phone: 770-962-3642