Provider Demographics
NPI:1528020732
Name:GRAYSTONE EAR, NOSE AND THROAT ASSOCIATES, PA
Entity Type:Organization
Organization Name:GRAYSTONE EAR, NOSE AND THROAT ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-322-3725
Mailing Address - Street 1:1781 TATE BLVD SE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4233
Mailing Address - Country:US
Mailing Address - Phone:828-322-3725
Mailing Address - Fax:828-322-2389
Practice Address - Street 1:1781 TATE BLVD SE
Practice Address - Street 2:SUITE 201
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4233
Practice Address - Country:US
Practice Address - Phone:828-322-3725
Practice Address - Fax:828-322-2389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38984207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902352Medicaid
NC230080AMedicare ID - Type Unspecified