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General NPI Number Information
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NPI Number | 1770815300
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Entity Type | Organization
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Legal Business Name | PREMIER SPINE PAIN & REHABILITATION
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Dates
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Enumeration Date | 02/07/2010
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Last Update Date | 06/23/2021
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Provider Practice Location Address
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Address Line | 2315 W ARBORS DR STE 115
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City | CHARLOTTE
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State | NC
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Zip | 28262-2639
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Country | US
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Telephone | 704-817-6676
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Fax | 704-817-6678
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Provider Business Mailing Address
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Address Line | PO BOX 480328
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City | CHARLOTTE
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State | NC
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Zip | 28269-5338
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Country | US
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Telephone | 215-669-9668
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. EDWARD ANTHONY OVERTON
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Credential | DO
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Telephone | 704-817-6676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 200400934
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License Number State | NC
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