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General NPI Number Information
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NPI Number | 1447618491
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Entity Type | Organization
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Legal Business Name | AVADA
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Dates
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Enumeration Date | 02/05/2016
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Last Update Date | 02/05/2016
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Provider Practice Location Address
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Address Line | 160 PINEHURST AVE STE G
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-7078
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Country | US
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Telephone | 910-692-4454
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Fax | 910-246-0583
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Provider Business Mailing Address
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Address Line | 160 PINEHURST AVE STE G
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-7078
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Country | US
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Telephone | 910-692-4454
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Fax | 910-246-0583
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Authorized Official
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Title or Position | CLINICIAN
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Name | DR. JAMES RYAN DIXON
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Credential | D.C.
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Telephone | 910-639-1557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State | NC
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