Organization
GASTON MEDICAL ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLUFOLARIN AKANFE AJAO M.D. (CO-PRESIDENT)
(704) 861-9030
Entity
Organization
Contact information
Practice address
2664 COURT DRIVE, SUITE A, GASTONIA, NC 28054-1449
(704) 861-9030
(704) 833-1234
Mailing address
2664 COURT DRIVE, SUITE A, GASTONIA, NC 28054-1449
(704) 861-9030
(704) 833-1234
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
9501167
NC
207RG0100X
Gastroenterology Physician
9600912
NC
363A00000X
Physician Assistant
0010-01441
NC
363L00000X
Nurse Practitioner
201734
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89011FH
—
NC
Enumeration date
11/03/2005
Last updated
07/31/2013
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