Provider Demographics
NPI:1720072150
Name:GRAMLEY, WILLIAM ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ANDREW
Last Name:GRAMLEY
Suffix:
Gender:M
Credentials:MD
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 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1520 PHYSICIANS DR
Practice Address - Street 2:STE B
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7356
Practice Address - Country:US
Practice Address - Phone:910-662-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300480207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC100011004OtherRAILROAD MEDICARE
NC8911320Medicaid
NC1720072150Medicaid
NC2251040Medicare PIN
NC100011004OtherRAILROAD MEDICARE
NC8911320Medicaid