Healthcare Provider Details

I. General information

NPI: 1194643163
Provider Name (Legal Business Name): GRAYSON MCCLAMROCK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 SHILOH CHURCH RD STE 202
DAVIDSON NC
28036-7603
US

IV. Provider business mailing address

508 GOLDMOOR DR NE
CONCORD NC
28025-2516
US

V. Phone/Fax

Practice location:
  • Phone: 704-403-7800
  • Fax:
Mailing address:
  • Phone: 704-796-8796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5024851
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: