Provider Demographics
NPI:1609345412
Name:GRANDY FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:GRANDY FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-491-2111
Mailing Address - Street 1:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:JARVISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27947-0211
Mailing Address - Country:US
Mailing Address - Phone:252-491-2111
Mailing Address - Fax:833-689-6836
Practice Address - Street 1:7429 CARATOKE HWY
Practice Address - Street 2:
Practice Address - City:JARVISBURG
Practice Address - State:NC
Practice Address - Zip Code:27947-9708
Practice Address - Country:US
Practice Address - Phone:252-491-2111
Practice Address - Fax:833-689-6830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-21
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty