Organization
FAIRGROVE RADIATION ONCOLOGY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GAYLA S LOWERY M.D. (PRESIDENT)
(704) 878-4615
Entity
Organization
Contact information
Practice address
557 BROOKDALE DR, STATESVILLE, NC 28677-4107
(704) 878-4615
(704) 878-7193
Mailing address
PO BOX 6297, STATESVILLE, NC 28687-6297
(704) 878-4615
(704) 878-7193
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
890153G
—
NC
Enumeration date
06/06/2007
Last updated
07/29/2010
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