Organization
GASTONIA MEDICAL SPECIALTY CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKELL J JARRATT MD (CORPORATE OFFICER - PRESIDENT)
(704) 867-2341
Entity
Organization
Contact information
Practice address
1021 X RAY DR, GASTONIA, NC 28054-7489
(704) 867-2341
(704) 867-9019
Mailing address
1021 X RAY DR, GASTONIA, NC 28054-7489
(704) 867-2341
(704) 867-9019
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01627
BCBSNC GROUP PROVIDER #
NC
05
—
5920537
—
NC
01
—
CC5252
RAILROAD MEDICARE
NC
05
—
NPA701
—
SC
Enumeration date
07/04/2006
Last updated
10/08/2014
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