Provider Demographics
NPI:1104020288
Name:GRIST, JAMES DONALD (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DONALD
Last Name:GRIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2168
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-2168
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:444 NC HWY 108
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-2406
Practice Address - Country:US
Practice Address - Phone:828-286-2302
Practice Address - Fax:828-287-4320
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10475207Q00000X
SC7509207Q00000X
NC9601785207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8910194Medicaid
NCP00976732OtherRAILROAD MEDICARE
NCNC1744A2343808Medicare PIN
NCP00976732OtherRAILROAD MEDICARE
C72295Medicare ID - Type Unspecified