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General NPI Number Information
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NPI Number | 1407577984
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Entity Type | Individual
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Provider Name | MADISON GRAY COBB FNP
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Gender | Female
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Dates
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Enumeration Date | 09/05/2022
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 1413 GREENWAY CT
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City | SANFORD
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State | NC
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Zip | 27330-6954
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Country | US
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Telephone | 919-292-2219
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Fax |
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Provider Business Mailing Address
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Address Line | 12082 NC 42
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City | FUQUAY VARINA
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State | NC
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Zip | 27526-9711
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Country | US
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Telephone | 919-906-2632
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5016826
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License Number State | NC
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