=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902647746
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. GARY MICHAEL ALSTON
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2024
-----------------------------------------------------
Last Update Date | 08/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1613 OWEN DR STE B
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28304-3425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-491-8934
-----------------------------------------------------
Fax | 910-491-7119
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1613 OWEN DR STE B
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28304-3425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-491-8934
-----------------------------------------------------
Fax | 910-491-7119
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | P022739
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------