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General NPI Number Information
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NPI Number | 1619348463
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Entity Type | Organization
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Legal Business Name | PREMIER PAIN PRACTICE PLLC
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Dates
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Enumeration Date | 10/19/2015
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Last Update Date | 10/28/2022
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Provider Practice Location Address
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Address Line | 1782 METROMEDICAL DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3861
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Country | US
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Telephone | 910-339-7951
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Fax | 910-339-7952
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Provider Business Mailing Address
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Address Line | 1782 METROMEDICAL DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3861
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Country | US
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Telephone | 910-339-7951
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Fax | 910-339-7952
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Authorized Official
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Title or Position | OWNER
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Name | DR. SANJAY B SHAH
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Credential | M.D.
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Telephone | 910-987-2571
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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 |
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License Number State |
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