Healthcare Provider Details

I. General information

NPI: 1962458943
Provider Name (Legal Business Name): GASTON WOMEN'S HEALTHCARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 ABERDEEN BLVD
GASTONIA NC
28054-0637
US

IV. Provider business mailing address

2680 ABERDEEN BLVD
GASTONIA NC
28054-0637
US

V. Phone/Fax

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

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: KELVIN C HARRIS
Title or Position: PRESIDENT
Credential: M.C.
Phone: 704-865-2229