# GRANVILLE FAMILY MEDICINE PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093713695
- **Authorized official:** DENNIS MICHAEL MAHAN MD (CEO)
- **Authorized official phone:** (919) 693-7108

## Contact information

- **Practice address:** 103 PROFESSIONAL PARK STE A, OXFORD, NC 27565-2581
- **Practice address phone:** (919) 693-7108
- **Practice address fax:** (919) 693-9245
- **Mailing address:** 103 PROFESSIONAL PARK STE A, OXFORD, NC 27565-2581
- **Mailing address phone:** (919) 693-7108
- **Mailing address fax:** (919) 693-9245

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 25053 | NC | Yes |
| 208000000X | Pediatrics Physician | 25053 | NC | — |

## Other

- **Enumeration date:** 07/08/2005
- **Last updated:** 09/15/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0171A | BCBSNC | NC |
| 05 | — | 343950A | — | NC |
| 05 | — | 343950C | — | NC |