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General NPI Number Information
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NPI Number | 1538235494
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Entity Type | Organization
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Legal Business Name | EASTERN CAROLINA PAIN MANAGEMENT CENTER INC
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2035 VALLEYGATE DR SUITE 201
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3688
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Country | US
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Telephone | 910-323-8454
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Fax | 910-321-0656
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Provider Business Mailing Address
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Address Line | PO BOX 3426
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City | WILMINGTON
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State | NC
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Zip | 28406-0426
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Country | US
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Telephone | 910-251-8474
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Fax | 910-251-2202
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Authorized Official
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Title or Position | PHYSICIAN DIRECTOR
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Name | DR. TONI HARRIS
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Credential | MD
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Telephone | 910-251-8474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 35361
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License Number State | NC
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