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General NPI Number Information
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NPI Number | 1871845172
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Entity Type | Organization
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Legal Business Name | AMEDCO NORTH CAROLINA LLC
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Dates
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Enumeration Date | 10/10/2012
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Last Update Date | 10/10/2012
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Provider Practice Location Address
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Address Line | 817 E MOREHEAD ST #200
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City | CHARLOTTE
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State | NC
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Zip | 28202-2700
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Country | US
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Telephone | 704-295-0001
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Fax | 704-295-0002
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Provider Business Mailing Address
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Address Line | 817 E MOREHEAD ST #200
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City | CHARLOTTE
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State | NC
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Zip | 28202-2700
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Country | US
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Telephone | 704-295-0001
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Fax | 704-295-0002
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | GALEN GRAYSON
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Credential | M.D.
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Telephone | 704-295-0001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State | NC
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