Organization
GRANVILLE FAMILY MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS MICHAEL MAHAN MD (CEO)
(919) 693-7108
Entity
Organization
Contact information
Practice address
103 PROFESSIONAL PARK STE A, OXFORD, NC 27565-2581
(919) 693-7108
(919) 693-9245
Mailing address
103 PROFESSIONAL PARK STE A, OXFORD, NC 27565-2581
(919) 693-7108
(919) 693-9245
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25053
NC
208000000X
Pediatrics Physician
25053
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0171A
BCBSNC
NC
05
—
343950A
—
NC
05
—
343950C
—
NC
Enumeration date
07/08/2005
Last updated
09/15/2014
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