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General NPI Number Information
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NPI Number | 1588937999
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Entity Type | Organization
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Legal Business Name | HEAG PAIN MANAGEMENT CENTER PA
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Dates
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Enumeration Date | 02/15/2012
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 203 POMONA DR
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City | GREENSBORO
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State | NC
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Zip | 27407-1619
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Country | US
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Telephone | 336-430-3727
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Fax |
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Provider Business Mailing Address
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Address Line | 203 POMONA DR
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City | GREENSBORO
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State | NC
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Zip | 27407-1619
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Country | US
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Telephone | 919-220-0107
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Fax | 336-282-6962
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. RANDALL NORRIS GRANT
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Credential |
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Telephone | 336-609-3801
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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 | 200500050
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License Number State | NC
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