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General NPI Number Information
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NPI Number | 1598743981
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Entity Type | Organization
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Legal Business Name | REHABILITATION MEDICINE & PAIN CENTER PC
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Dates
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Enumeration Date | 01/05/2006
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Last Update Date | 09/18/2007
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Provider Practice Location Address
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Address Line | 114 WELTON WAY SUITE A
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City | MOORESVILLE
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State | NC
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Zip | 28117-9163
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Country | US
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Telephone | 704-664-5766
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Fax | 704-664-9311
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Provider Business Mailing Address
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Address Line | 114 WELTON WAY SUITE A
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City | MOORESVILLE
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State | NC
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Zip | 28117-9163
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Country | US
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Telephone | 704-664-5766
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Fax | 704-664-9311
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK ALLEN GOODSON
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Credential | MD
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Telephone | 704-664-5766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 97-01373
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License Number State | NC
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