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General NPI Number Information
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NPI Number | 1649236845
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Entity Type | Organization
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Legal Business Name | HEADACHE WELLNESS CENTER PC
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 08/01/2007
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Provider Practice Location Address
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Address Line | 1414 YANCEYVILLE STREET FIRST FLOOR
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City | GREENSBORO
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State | NC
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Zip | 27405-6930
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Country | US
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Telephone | 336-574-8000
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Fax | 336-574-8008
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Provider Business Mailing Address
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Address Line | 1414 YANCEYVILLE STREET FIRST FLOOR
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City | GREENSBORO
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State | NC
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Zip | 27405-6930
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Country | US
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Telephone | 336-574-8000
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Fax | 336-574-8008
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Authorized Official
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Title or Position | CO OWNER
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Name | MARSHALL C FREEMAN
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Credential | MD
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Telephone | 336-574-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 84461
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License Number State | NC
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