Provider Demographics
NPI:1710159454
Name:GREMILLION, DAVID HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HENRY
Last Name:GREMILLION
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 CALLINESS WAY
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4457
Mailing Address - Country:US
Mailing Address - Phone:919-790-1227
Mailing Address - Fax:
Practice Address - Street 1:2816 CALLINESS WAY
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4457
Practice Address - Country:US
Practice Address - Phone:919-790-1227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32504207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease