Provider Demographics
NPI:1114952322
Name:NORRIS, JOHN GRAY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GRAY
Last Name:NORRIS
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 63376
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3376
Mailing Address - Country:US
Mailing Address - Phone:704-372-7900
Mailing Address - Fax:704-376-2216
Practice Address - Street 1:2600 E 7TH ST
Practice Address - Street 2:UNIT A
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-4375
Practice Address - Country:US
Practice Address - Phone:704-372-7900
Practice Address - Fax:704-376-2216
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500677207K00000X
NC95-00677207K00000X
SC20140207K00000X
GA042376207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89111QMedicaid
SCPC6542GROUPMedicaid
NCBCBSOther01284
SCN00677Medicaid
G65848Medicare UPIN
SCPC6542GROUPMedicaid
NC89111QMedicaid