Provider Demographics
NPI:1609268689
Name:FACIALS & FILLERS AESTHETICS CENTER
Entity Type:Organization
Organization Name:FACIALS & FILLERS AESTHETICS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HALL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:252-240-3223
Mailing Address - Street 1:5056 HWY 70 W
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4502
Mailing Address - Country:US
Mailing Address - Phone:252-240-3223
Mailing Address - Fax:252-499-9004
Practice Address - Street 1:5056 HWY 70 W
Practice Address - Street 2:SUITE A
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4502
Practice Address - Country:US
Practice Address - Phone:252-240-3223
Practice Address - Fax:252-499-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24073261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1902095920OtherGENERIC NPI