MEDICARE: GRAYJONES COURIER LOGISTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver

General Provider Information

NPI Number	:	1043832561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAYJONES COURIER LOGISTICS LLC

Provider Business Mailing Address
First Line	:	5009 BEATTIES FORD RD STE 107-357
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-2859
Country	:	US
Telephone Number	:	704-775-1978
Fax Number	:

Provider Business Practice Location Address
First Line	:	8119 BELLA VISTA CT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-2003
Country	:	US
Telephone Number	:	704-775-1978
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	COURTNEY JONES
Credential	:
Telephone Number	:	704-775-1978

Provider Enumeration Date	:	05/07/2020
Last Update Date	:	05/07/2020

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