Individual
JAY GRAYSON FERNANDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7615 COLONY RD, STE 115, CHARLOTTE, NC 28226-5017
(704) 626-6812
(704) 626-6824
Mailing address
7615 COLONY RD, STE 115, CHARLOTTE, NC 28226-5017
(704) 626-6812
(704) 626-6824
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
9901172
NC
207R00000X
Internal Medicine Physician
Primary
9901172
NC
207RA0401X
Addiction Medicine (Internal Medicine) Physician
9901172
NC
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
9901172
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891235U
—
NC
Enumeration date
05/25/2006
Last updated
06/20/2024
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