Healthcare Provider Details

I. General information

NPI: 1417672627
Provider Name (Legal Business Name): GASTON FAMILY HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S FAYETTEVILLE ST
ASHEBORO NC
27205-7368
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 336-318-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: SHARMILA ALEXANDER ANDERSON
Title or Position: MEDICAL BILLING & CODING SUPERVISOR
Credential:
Phone: 704-874-1907