# GASTON FAMILY PRACTICE PLLC

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

## Provider details

- **NPI number:** 1316656481
- **Authorized official:** DEREK REED DO (ADMINISTRATION)
- **Authorized official phone:** (704) 867-1402

## Contact information

- **Practice address:** 2290 REMOUNT RD, GASTONIA, NC 28054-4725
- **Practice address phone:** (704) 867-1402
- **Practice address fax:** (888) 720-2814
- **Mailing address:** 2290 REMOUNT RD, GASTONIA, NC 28054-4725
- **Mailing address phone:** (704) 867-1402
- **Mailing address fax:** (704) 671-2028

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/17/2022
- **Last updated:** 11/12/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1306896147 | — | NC |
| 05 | — | 1629271440 | — | NC |
| 05 | — | 1912930009 | — | NC |