Healthcare Provider Details

I. General information

NPI: 1821912833
Provider Name (Legal Business Name): GREGORY SPENCER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 JAY ST STE 300
CHARLOTTE NC
28208-4479
US

IV. Provider business mailing address

527 WILSON FARM RD
GASTONIA NC
28056-8518
US

V. Phone/Fax

Practice location:
  • Phone: 864-991-6185
  • Fax:
Mailing address:
  • Phone: 864-991-6185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP576702
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: