Organization
EASTERN HEADACHE AND SPINE, PA
Active
Organization
EASTERN HEADACHE AND SPINE, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES BRYAN COOPER MD (OWNER)
(252) 215-3067
Entity
Organization
Contact information
Practice address
498 A RED BANKS ROAD, GREENVILLE, NC 27858
(252) 215-3067
Mailing address
498 A RED BANKS ROAD, GREENVILLE, NC 27858
(252) 215-3067
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
200400320
NC
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
200400320
NC
2085N0700X
Neuroradiology Physician
200400320
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1363X
BLUE CROSS BLUE SHIELD
—
05
—
891363X
—
NC
Enumeration date
07/16/2009
Last updated
03/11/2010
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