Healthcare Provider Details

I. General information

NPI: 1710237367
Provider Name (Legal Business Name): GASTON FAMILY HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 BROOKDALE DR
STATESVILLE NC
28677-4108
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 704-872-9595
  • Fax: 704-872-5851
Mailing address:
  • Phone: 704-874-1904
  • Fax: 704-867-2134

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 SERVICE ADMINISTRATOR
Credential:
Phone: 704-874-1907