Individual
TIM GRAVGAARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
117 MATTHEWS DR, ELIZABETH CITY, NC 27909-7739
(757) 618-9866
Mailing address
117 MATTHEWS DR, ELIZABETH CITY, NC 27909-7739
(757) 618-9866
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
20899329
NC
Other
Enumeration date
07/03/2023
Last updated
07/03/2023
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