Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | 1146 | SC |
Y | 2081P2900X | Pain Medicine | 200400934 | NC |
N | 2081P2900X | Pain Medicine | 53011 | GA |
N | 2081P2900X | Pain Medicine | OS-010979L | PA |
NPI | 1093753329 |
---|---|
Provider Name | Dr. Edward Anthony Overton |
First Address | Charlotte, NC 28269-5338 |
Second Address | Charlotte, NC 28262-2639 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 23/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2335844000 | IBC (01) | PA |
3686882 | AETNA (01) | PA |
5908315 | (05) | NC |
6738998 | CIGNA (01) | |
I17524 | (02) | |
NC1316 | (05) | SC |