Healthcare Provider Details

I. General information

NPI: 1619627056
Provider Name (Legal Business Name): ALSTON GRAY ENZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 S 17TH ST
WILMINGTON NC
28401-7407
US

IV. Provider business mailing address

1202 MEDICAL CENTER DR
WILMINGTON NC
28401-7307
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-7000
  • Fax: 910-667-5650
Mailing address:
  • Phone: 910-341-1540
  • Fax: 910-431-4048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2025-00600
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: