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General NPI Number Information
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NPI Number | 1720352230
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Entity Type | Organization
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Legal Business Name | PERSONALIZED SPINE & PAIN CARE P.C
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Dates
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Enumeration Date | 03/01/2012
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 1160 VARNUM ST NE SUITE 212
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City | WASHINGTON
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State | DC
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Zip | 20017-2107
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Country | US
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Telephone | 202-507-8444
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Fax | 202-507-8503
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Provider Business Mailing Address
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Address Line | PO BOX 29397
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City | WASHINGTON
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State | DC
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Zip | 20017-0397
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Country | US
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Telephone | 866-301-4762
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. AYASHA L'DAIRE WILLIAMS-SHARRON
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Credential | M.D.
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Telephone | 866-301-4762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081H0002X
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Taxonomy Name | Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | D0070038
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License Number State | MD
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