Healthcare Provider Details

I. General information

NPI: 1205251766
Provider Name (Legal Business Name): GASTON FAMILY HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 REMOUNT RD
GASTONIA NC
28054-7413
US

IV. Provider business mailing address

200 E SECOND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 855-327-7852
  • Fax: 704-865-4785
Mailing address:
  • Phone: 704-874-1907
  • Fax: 704-874-0707

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 ANDERSON
Title or Position: BUSINESS SERVICES ADMINISTRATOR
Credential:
Phone: 704-874-1907