Healthcare Provider Details

I. General information

NPI: 1326235821
Provider Name (Legal Business Name): GASTON FAMILY HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 SHELTON AVE
STATESVILLE NC
28677-6826
US

IV. Provider business mailing address

1022 SHELTON AVE
STATESVILLE NC
28677-6826
US

V. Phone/Fax

Practice location:
  • Phone: 704-838-1234
  • Fax: 704-768-2081
Mailing address:
  • Phone: 704-768-2080
  • Fax: 704-768-2085

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