Healthcare Provider Details

I. General information

NPI: 1639176316
Provider Name (Legal Business Name): GRACE MCCALL AUTEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 41ST AVENUE PL NW
HICKORY NC
28601-9028
US

IV. Provider business mailing address

307 41ST AVENUE PL NW
HICKORY NC
28601-9028
US

V. Phone/Fax

Practice location:
  • Phone: 828-304-4935
  • Fax: 828-304-4936
Mailing address:
  • Phone: 828-304-4935
  • Fax: 828-304-4936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12579
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number99-00415
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number9900415
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: