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General NPI Number Information
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NPI Number | 1063556728
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Entity Type | Organization
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Legal Business Name | DOUGLAS DUSSEL PRITCHARD MD PLLC
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 610 SIGNAL HILL DRIVE EXT SUITE 100
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City | STATESVILLE
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State | NC
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Zip | 28625-4337
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Country | US
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Telephone | 704-818-0480
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Fax | 704-818-0490
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Provider Business Mailing Address
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Address Line | 610 SIGNAL HILL DRIVE EXT SUITE 100
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City | STATESVILLE
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State | NC
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Zip | 28625-4337
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Country | US
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Telephone | 704-818-0480
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Fax | 704-818-0490
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOUGLAS DUSSEL PRITCHARD
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Credential | M.D.
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Telephone | 704-818-0840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 18045
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 10845
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License Number State | NC
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