Healthcare Provider Details

I. General information

NPI: 1427868504
Provider Name (Legal Business Name): CASSANDRA S GREGORY DR. OF EDUCATION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CASSANDRA S GREGORY CASSANDRA GREGORY

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 CATHERINE SIMMONS AVE
CHARLOTTE NC
28216-4677
US

IV. Provider business mailing address

8800 SHADY PINE CT
CHARLOTTE NC
28214-7116
US

V. Phone/Fax

Practice location:
  • Phone: 704-492-1533
  • Fax:
Mailing address:
  • Phone: 704-287-1935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number736559
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: