Healthcare Provider Details

I. General information

NPI: 1346925005
Provider Name (Legal Business Name): GRACE OBGYN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 09/02/2025
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 YORKSHIRE ST
ASHEVILLE NC
28803-2752
US

IV. Provider business mailing address

PO BOX 12860
BELFAST ME
04915-4019
US

V. Phone/Fax

Practice location:
  • Phone: 828-252-1050
  • Fax: 828-253-0457
Mailing address:
  • Phone: 919-334-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: ERICA HERNANDEZ
Title or Position: DIRECTOR
Credential:
Phone: 561-300-2410