Healthcare Provider Details

I. General information

NPI: 1023166188
Provider Name (Legal Business Name): CMG- GASTON WOMEN'S HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 ABERDEEN BLVD SUITE A
GASTONIA NC
28054-0637
US

IV. Provider business mailing address

2240 REMOUNT RD
GASTONIA NC
28054-4725
US

V. Phone/Fax

Practice location:
  • Phone: 704-865-2229
  • Fax: 704-865-2811
Mailing address:
  • Phone: 704-671-5311
  • Fax: 704-671-5308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: VALINDA L RUTLEDGE
Title or Position: PRESIDENT,CEO
Credential:
Phone: 704-834-2133