Healthcare Provider Details

I. General information

NPI: 1366738361
Provider Name (Legal Business Name): GRAYSTONE FAMILY HEALTHCARE-TENET NORTH CAROLINA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 06/07/2016
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

PO BOX 741610
ATLANTA GA
30374-1610
US

V. Phone/Fax

Practice location:
  • Phone: 828-326-9355
  • Fax: 828-326-9868
Mailing address:
  • Phone: 828-326-9355
  • Fax: 828-326-9868

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: WESLEY O. JAMES
Title or Position: REGIONAL CFO, TENET
Credential:
Phone: 404-265-5009