Provider Demographics
NPI:1679228639
Name:EUBANKS, GWENDOLYN ELAINE (MEDICAL ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:ELAINE
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
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Mailing Address - Street 1:7225 HUNTERS SPRING DR.
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1247
Mailing Address - Country:US
Mailing Address - Phone:704-910-5053
Mailing Address - Fax:704-910-5052
Practice Address - Street 1:1404 BEATTIES FORD ROAD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-4578
Practice Address - Country:US
Practice Address - Phone:704-910-5053
Practice Address - Fax:704-910-5052
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-05-24
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)