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General NPI Number Information
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NPI Number | 1457735029
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Entity Type | Organization
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Legal Business Name | PERSONALIZED SPINE AND PAIN CARE
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Dates
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Enumeration Date | 07/14/2015
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 6475 NEW HAMPSHIRE AVE STE C200A
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City | HYATTSVILLE
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State | MD
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Zip | 20783-3269
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Country | US
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Telephone | 844-940-7246
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Fax | 301-270-2102
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Provider Business Mailing Address
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Address Line | 4807 ESSEX AVE
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City | CHEVY CHASE
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State | MD
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Zip | 20815-5547
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Country | US
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Telephone | 844-940-7246
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Fax | 301-270-2102
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Authorized Official
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Title or Position | PRESIDENT
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Name | AYASHA WILLIAMS-SHARRON
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Credential | MD
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Telephone | 844-940-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | MD038938
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License Number State | DC
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