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Organization

GRACE WOMENS CLINIC PA

Active
Other names
GRACE WOMENS CLINIC
Organization subpart
No

Provider details

NPI number
Authorized official
DR. LYNDE KNOWLES-JONAS MD (PHYSICIAN)
(336) 538-2014
Entity
Organization

Contact information

Practice address
2280 S CHURCH ST STE 201, SUITE 201, BURLINGTON, NC 27215-5397
(336) 538-2014
(336) 538-2015
Mailing address
2280 S CHURCH ST STE 201, SUITE 201, BURLINGTON, NC 27215-5397
(336) 538-2014
(336) 538-2015

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
9800935
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
022135915
D-U-N-S#
01
023X3
BCBS GROUP#
01
1053375535
RENDERING PROVIDER NPI
01
1871786673
GROUP NPI
01
2260309A
PROVIDER PTAN
01
2349572
MEDICARE GROUP NUMBER
NC
05
7911368
NC
Enumeration date
08/24/2007
Last updated
04/24/2012
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