Organization
CAROLINA SPINE, PAIN AND REHABILITATION PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HERMAN CLARK GORE MD (CEO)
(704) 864-3300
Entity
Organization
Contact information
Practice address
900 COX RD, STE A, GASTONIA, NC 28054-3460
(704) 864-3300
(704) 864-2002
Mailing address
PO BOX 550700, GASTONIA, NC 28055-0700
(704) 864-3300
(704) 864-2002
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020JA
BLUECROSS BLUESHIELD
NC
05
—
5950164
—
NC
05
—
7705149
—
NC
05
—
N00851
—
SC
Enumeration date
04/26/2006
Last updated
12/07/2022
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