Provider Demographics
NPI:1457735029
Name:PERSONALIZED SPINE AND PAIN CARE
Entity Type:Organization
Organization Name:PERSONALIZED SPINE AND PAIN CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AYASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS-SHARRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-507-8444
Mailing Address - Street 1:PO BOX 29397
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-0397
Mailing Address - Country:US
Mailing Address - Phone:202-507-8444
Mailing Address - Fax:202-507-8503
Practice Address - Street 1:1160 VARNUM ST NE
Practice Address - Street 2:SUITE 212
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2107
Practice Address - Country:US
Practice Address - Phone:202-050-7844
Practice Address - Fax:202-507-8503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD038938261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain