Healthcare Provider Details

I. General information

NPI: 1538185988
Provider Name (Legal Business Name): GRACE OB GYN PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 YORKSHIRE ST
ASHEVILLE NC
28803-2752
US

IV. Provider business mailing address

2 YORKSHIRE ST
ASHEVILLE NC
28803-2752
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LAURA BROOME
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 828-412-8078