Healthcare Provider Details

I. General information

NPI: 1356075261
Provider Name (Legal Business Name): GORDON MITCHELL LAYTON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15441 US HIGHWAY 17 STE 501
HAMPSTEAD NC
28443-0016
US

IV. Provider business mailing address

15441 US HIGHWAY 17 STE 501
HAMPSTEAD NC
28443-0016
US

V. Phone/Fax

Practice location:
  • Phone: 910-685-7307
  • Fax: 910-685-7284
Mailing address:
  • Phone: 910-685-7307
  • Fax: 910-685-7284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: