Healthcare Provider Details

I. General information

NPI: 1871845172
Provider Name (Legal Business Name): AMEDCO NORTH CAROLINA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 E MOREHEAD ST #200
CHARLOTTE NC
28202-2700
US

IV. Provider business mailing address

817 E MOREHEAD ST #200
CHARLOTTE NC
28202-2700
US

V. Phone/Fax

Practice location:
  • Phone: 704-295-0001
  • Fax: 704-295-0002
Mailing address:
  • Phone: 704-295-0001
  • Fax: 704-295-0002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNC

VIII. Authorized Official

Name: GALEN GRAYSON
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: M.D.
Phone: 704-295-0001