Basic Information
| Provider Information | |||||||||
| NPI: | 1669511143 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GOLDSBORO PAIN MEDICINE, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1208 PARKWAY DR STE C | ||||||||
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| City: | GOLDSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275349432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197518444 | ||||||||
| FaxNumber: | 9197510890 | ||||||||
| Practice Location | |||||||||
| Address1: | 1208 PARKWAY DR STE C | ||||||||
| Address2: | |||||||||
| City: | GOLDSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275349432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197518444 | ||||||||
| FaxNumber: | 9197510890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LONG | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
| AuthorizedOfficialMiddleName: | MORGAN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9197518444 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204D00000X | 107402 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM |
No ID Information.