Healthcare Provider Details

I. General information

NPI: 1124483607
Provider Name (Legal Business Name): DLP GRAYSTONE FAMILY PRACTICE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 01/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3511 GRAYSTONE PL SE
CONOVER NC
28613-8201
US

IV. Provider business mailing address

3511 GRAYSTONE PL SE
CONOVER NC
28613-8201
US

V. Phone/Fax

Practice location:
  • Phone: 615-920-7000
  • Fax:
Mailing address:
  • Phone: 615-920-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JESS N JUDY
Title or Position: PRESIDENT
Credential:
Phone: 615-920-7000