Provider Demographics
NPI:1851379424
Name:WATAUGA WOMEN'S CENTER, PLLC
Entity Type:Organization
Organization Name:WATAUGA WOMEN'S CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:FABRY
Authorized Official - Last Name:GRASINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-264-5464
Mailing Address - Street 1:870 STATE FARM RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4861
Mailing Address - Country:US
Mailing Address - Phone:828-264-5464
Mailing Address - Fax:828-264-5488
Practice Address - Street 1:870 STATE FARM RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4861
Practice Address - Country:US
Practice Address - Phone:828-264-5464
Practice Address - Fax:828-264-5488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89015XMMedicaid
NC2340645Medicare ID - Type Unspecified