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General NPI Number Information
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NPI Number | 1952674277
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Entity Type | Organization
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Legal Business Name | HEAG PAIN MANAGEMENT CENTER PA
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 2245 STANTONSBURG RD STE H
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City | GREENVILLE
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State | NC
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Zip | 27834
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Country | US
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Telephone | 252-364-2830
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 63082
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City | CHARLOTTE
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State | NC
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Zip | 28263-3082
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Country | US
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Telephone | 919-220-0107
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. RANDALL NORRIS GRANT
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Credential |
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Telephone | 336-282-0132
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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 | 200500050
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License Number State | NC
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