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General NPI Number Information
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NPI Number | 1780944314
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Entity Type | Individual
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Provider Name | JESSICA LYNN GRASS MD
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Gender | Female
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 02/07/2022
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Provider Practice Location Address
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Address Line | 4235 S NEW HOPE RD
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City | GASTONIA
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State | NC
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Zip | 28056-8453
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Country | US
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Telephone | 704-825-4750
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Fax | 704-825-6985
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Provider Business Mailing Address
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Address Line | PO BOX 744786
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City | ATLANTA
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State | GA
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Zip | 30374-4786
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Country | US
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Telephone | 704-834-2450
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Fax | 704-671-5331
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 182781
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2015-00273
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License Number State | NC
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