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General NPI Number Information
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NPI Number | 1669663175
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Entity Type | Organization
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Legal Business Name | ADDICTION RECOVERY MEDICAL SERVICES - PROVIDERS
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 05/01/2024
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Provider Practice Location Address
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Address Line | 536 SIGNAL HILL DR EXT
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City | STATESVILLE
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State | NC
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Zip | 28625
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Country | US
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Telephone | 704-872-0234
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Fax | 704-818-1115
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Provider Business Mailing Address
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Address Line | PO BOX 1545
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City | STATESVILLE
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State | NC
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Zip | 28687
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Country | US
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Telephone | 704-880-4612
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Fax | 704-818-1115
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Authorized Official
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Title or Position | MD, MEDICAL DIRECTOR
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Name | MR. BOBBY PAXTON KEARNEY
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Credential | MD
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Telephone | 704-880-5221
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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 | 9300179
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License Number State | NC
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