Provider Demographics
NPI:1528952322
Name:FAYETTEVILLE LASER CENTER PLLC
Entity type:Organization
Organization Name:FAYETTEVILLE LASER CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:910-447-5235
Mailing Address - Street 1:4140 FERNCREEK DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2564
Mailing Address - Country:US
Mailing Address - Phone:910-447-5235
Mailing Address - Fax:910-447-5236
Practice Address - Street 1:4140 FERNCREEK DR STE 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2564
Practice Address - Country:US
Practice Address - Phone:910-447-5235
Practice Address - Fax:910-447-5236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center