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General NPI Number Information
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NPI Number | 1689878118
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Entity Type | Organization
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Legal Business Name | PAIN AND LASER CENTE PA
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 03/16/2012
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Provider Practice Location Address
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Address Line | 1840 OWEN DRIVE SUITE 103
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3455
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Country | US
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Telephone | 910-223-7246
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Fax | 910-223-7247
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Provider Business Mailing Address
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Address Line | PO BOX 40107
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City | FAYETTEVILLE
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State | NC
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Zip | 28309-0107
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Country | US
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Telephone | 910-223-7246
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Fax | 910-223-7247
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MICHELLE APPLING
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Credential |
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Telephone | 910-223-7246
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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 | 200200534
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License Number State | NC
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