Individual
GRACIOUS JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
8450 PARK RD, CHARLOTTE, NC 28210-5801
(980) 308-0143
(980) 308-0142
Mailing address
PO BOX 601843, CHARLOTTE, NC 28260-1843
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-09395
NC
363A00000X
Physician Assistant
0160607
NY
Other
Enumeration date
06/14/2012
Last updated
10/26/2020
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