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NPI Code Detail

MEDICARE: JESSICA LYNN GRASS MD

MEDICARE: JESSICA LYNN GRASS MD
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
1207Q00000XFamily Medicine Physician182781NC
2207Q00000XFamily Medicine Physician2015-00273NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
119DJ7OTHERNCBCBS OF NC
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780944314
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA LYNN GRASS MD
Provider Business Mailing Address
First Line : PO BOX 744786
Second Line :
City : ATLANTA
State : GA
Zip : 30374-4786
Country : US
Telephone Number : 704-834-2450
Fax Number : 704-671-5331
Provider Business Practice Location Address
First Line : 4235 S NEW HOPE RD
Second Line :
City : GASTONIA
State : NC
Zip : 28056-8453
Country : US
Telephone Number : 704-825-4750
Fax Number : 704-825-6985
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2012
Last Update Date : 02/07/2022

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