Provider Demographics
NPI:1629082656
Name:JACHIM, GRETCHEN M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:M
Last Name:JACHIM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 CAMERON VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-3546
Mailing Address - Country:US
Mailing Address - Phone:704-367-7400
Mailing Address - Fax:704-367-7444
Practice Address - Street 1:4501 CAMERON VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-3546
Practice Address - Country:US
Practice Address - Phone:704-367-7400
Practice Address - Fax:704-367-7444
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102764363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2759452Medicare ID - Type Unspecified
NCC81890Medicare UPIN