Provider Demographics
NPI:1922402452
Name:RETSON, GREGORY (PA)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:RETSON
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 603949
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3949
Mailing Address - Country:US
Mailing Address - Phone:919-350-8991
Mailing Address - Fax:919-350-7687
Practice Address - Street 1:601 OBERLIN RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1126
Practice Address - Country:US
Practice Address - Phone:919-789-4322
Practice Address - Fax:919-789-4533
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2022-12-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC001005122363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant