# SOZO HEALTH PAVILION, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538111414
- **Authorized official:** MRS. PHYLLIS AYCOCK WILLIAMS R.N. (MANAGER)
- **Authorized official phone:** (910) 455-7110

## Contact information

- **Practice address:** 615 COLLEGE ST, JACKSONVILLE, NC 28540-5310
- **Practice address phone:** (910) 455-7110
- **Practice address fax:** (910) 455-7938
- **Mailing address:** PO BOX 7105, JACKSONVILLE, NC 28540-2105
- **Mailing address phone:** (910) 455-7110
- **Mailing address fax:** (910) 455-7938

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | 28713 | NC | — |
| 101YP1600X | Pastoral Counselor | 28713 | NC | — |
| 163WG0000X | General Practice Registered Nurse | 082155 | NC | — |
| 207Q00000X | Family Medicine Physician | 28713 | NC | — |
| 207QA0401X | Addiction Medicine (Family Medicine) Physician | 28713 | NC | — |
| 207QA0505X | Adult Medicine Physician | 28713 | NC | Yes |
| 207VG0400X | Gynecology Physician | 28713 | NC | — |
| 2083P0901X | Public Health & General Preventive Medicine Physician | 28713 | NC | — |
| 208D00000X | General Practice Physician | 28713 | NC | — |
| 251S00000X | Community/Behavioral Health Agency | 28713 | NC | — |

## Other

- **Enumeration date:** 05/17/2006
- **Last updated:** 02/28/2011