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General NPI Number Information
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NPI Number | 1497713952
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Entity Type | Individual
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Provider Name | GRANT ANDERSON BERRY MACCCA
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Gender | Male
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 06/04/2015
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Provider Practice Location Address
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Address Line | 870 STATE FARM RD STE 303
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City | BOONE
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State | NC
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Zip | 28607-4861
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Country | US
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Telephone | 828-264-4545
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Fax | 828-264-3279
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Provider Business Mailing Address
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Address Line | 870 STATE FARM RD STE 303
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City | BOONE
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State | NC
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Zip | 28607-4861
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Country | US
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Telephone | 828-264-4545
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Fax | 828-264-3279
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 2700
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License Number State | NC
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