Healthcare Provider Details

I. General information

NPI: 1821494725
Provider Name (Legal Business Name): JUSTIS PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 HINES ST W SUITE B
WILSON NC
27893-3022
US

IV. Provider business mailing address

1201 SCHOOL ST SUITE C
WILKESBORO NC
28697-2629
US

V. Phone/Fax

Practice location:
  • Phone: 252-237-2461
  • Fax: 252-399-0569
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number38991
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. CHRISTOPHER JUSTIS
Title or Position: DOCTOR
Credential: M.D.
Phone: 336-990-0595