Provider Demographics
NPI:1366495707
Name:GRANFORTUNA, JAMES MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MITCHELL
Last Name:GRANFORTUNA
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 405633
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5633
Mailing Address - Country:US
Mailing Address - Phone:336-832-3677
Mailing Address - Fax:336-832-3681
Practice Address - Street 1:501 N ELAM AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1118
Practice Address - Country:US
Practice Address - Phone:336-832-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39602207R00000X
NC90308207RH0003X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8936721Medicaid
NC37875OtherMEDCOST
NC5644OtherMEDICARE PARTNERS
NC5994101OtherAETNA
NC36721OtherBCBS NC
NC2154424BMedicare ID - Type UnspecifiedMEDICARE
NC8936721Medicaid