Healthcare Provider Details

I. General information

NPI: 1174767073
Provider Name (Legal Business Name): GASTON FAMILY HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 N HIGHLAND ST
GASTONIA NC
28052-2179
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 704-772-4700
  • Fax: 704-833-1553
Mailing address:
  • Phone: 704-874-1904
  • Fax: 704-864-7608

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 ADMIN
Credential:
Phone: 704-874-1907