MEDICARE: SAMETTA GRIGSBY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	261Q00000X	Clinic/Center	NC
2	261QH0100X	Health Service Clinic/Center	NC
3	171400000X	Health & Wellness Coach	NC

General Provider Information

NPI Number	:	1366071748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMETTA GRIGSBY

Provider Business Mailing Address
First Line	:	5982 BROOKSTONE DR NW
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28027-2533
Country	:	US
Telephone Number	:	980-785-8676
Fax Number	:

Provider Business Practice Location Address
First Line	:	5982 BROOKSTONE DR NW
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28027-2533
Country	:	US
Telephone Number	:	980-785-8676
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2020
Last Update Date	:	01/17/2026

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Directions to “ SAMETTA GRIGSBY ” Practice Location

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