| NPI | 1518532126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDY N MOUNTCASTLE Member, Organizer, Owner, CEO, Pa C 910-890-6590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine |
| 207QA0401X Family Medicine, Addiction Medicine | |
| 207QS1201X Family Medicine, Sleep Medicine | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2021-07-12 |