Provider Demographics
NPI:1639176316
Name:AUTEN, GRACE MCCALL (MD)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:MCCALL
Last Name:AUTEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:307 41ST AVENUE PL NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-9028
Mailing Address - Country:US
Mailing Address - Phone:828-304-4935
Mailing Address - Fax:828-304-4936
Practice Address - Street 1:307 41ST AVENUE PL NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-9028
Practice Address - Country:US
Practice Address - Phone:828-304-4935
Practice Address - Fax:828-304-4936
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900415207RI0200X
MT12579207R00000X
NC99-00415207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0190GOtherBCBS OF NC
NC790190GMedicaid
NC2276542Medicare PIN
E67362Medicare UPIN
NC790190GMedicaid