Provider Demographics
NPI:1396535662
Name:DIMICK, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:DIMICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 DEAN HALL LN
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-0921
Mailing Address - Country:US
Mailing Address - Phone:207-653-1740
Mailing Address - Fax:
Practice Address - Street 1:1118 DEAN HALL LN
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-0921
Practice Address - Country:US
Practice Address - Phone:207-653-1740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant