Healthcare Provider Details

I. General information

NPI: 1114322922
Provider Name (Legal Business Name): GASTON FAMILY HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 S OAKLAND ST
GASTONIA NC
28052-4312
US

IV. Provider business mailing address

200 E SECOND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 704-874-9005
  • Fax: 704-874-9001
Mailing address:
  • Phone: 704-874-1904
  • Fax: 704-867-2134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: SHARMILA ALEXANDER ANDERSON
Title or Position: BUSINESS SERVICE ADMINISTRATOR
Credential:
Phone: 704-874-1907