Healthcare Provider Details

I. General information

NPI: 1659943108
Provider Name (Legal Business Name): RISE UP ADDICTION MEDICINE & PAIN MANAGEMENT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W 5TH ST STE 800
WINSTON SALEM NC
27101-3131
US

IV. Provider business mailing address

500 W 5TH ST STE 800
WINSTON SALEM NC
27101-3131
US

V. Phone/Fax

Practice location:
  • Phone: 336-247-1068
  • Fax:
Mailing address:
  • Phone: 336-247-1068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ROYALL JR.
Title or Position: OWNER
Credential: FNP
Phone: 336-248-1068