Provider Demographics
NPI:1184186611
Name:FLETCHER, ALEX GRAYSON
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:GRAYSON
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:910-721-4000
Mailing Address - Fax:910-721-4001
Practice Address - Street 1:257 HOSPITAL DR NE STE 200
Practice Address - Street 2:
Practice Address - City:BOLIVIA
Practice Address - State:NC
Practice Address - Zip Code:28422-8411
Practice Address - Country:US
Practice Address - Phone:910-721-4000
Practice Address - Fax:910-721-4001
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2024-01754208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program