Provider Demographics
NPI:1841844552
Name:GROSS, PERRI POTTER (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:PERRI
Middle Name:POTTER
Last Name:GROSS
Suffix:
Gender:F
Credentials:RD, LDN
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 677
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28093-0677
Mailing Address - Country:US
Mailing Address - Phone:980-212-6035
Mailing Address - Fax:
Practice Address - Street 1:433 MCALISTER RD
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4147
Practice Address - Country:US
Practice Address - Phone:980-212-6035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86098767133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered