Provider Demographics
NPI:1376667154
Name:G&G HEALTHCARE, PC CERRO GORDO
Entity Type:Organization
Organization Name:G&G HEALTHCARE, PC CERRO GORDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARVIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:GERLAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-642-2050
Mailing Address - Street 1:7490 ANDREW JACKSON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:CERRO GORDO
Mailing Address - State:NC
Mailing Address - Zip Code:28430
Mailing Address - Country:US
Mailing Address - Phone:910-654-2050
Mailing Address - Fax:910-654-1258
Practice Address - Street 1:7490 ANDREW JACKSON HIGHWAY
Practice Address - Street 2:
Practice Address - City:CERRO GORDO
Practice Address - State:NC
Practice Address - Zip Code:28430
Practice Address - Country:US
Practice Address - Phone:910-654-2050
Practice Address - Fax:910-654-1258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89089JMedicaid