| Granville Family Medicine Pa | |
|
103 Professional Park Ste A Oxford NC 27565-2581 | |
| (919) 693-7108 | |
| (919) 693-9245 |
| Full Name | Granville Family Medicine Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 103 Professional Park Ste A, Oxford, North Carolina |
| Authorized Official Name and Position | Dennis Michael Mahan (CEO) |
| Authorized Official Contact | 9196937108 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Granville Family Medicine Pa 103 Professional Park Ste A Oxford NC 27565-2581 Ph: (919) 693-7108 | Granville Family Medicine Pa 103 Professional Park Ste A Oxford NC 27565-2581 Ph: (919) 693-7108 |
| NPI Number | 1093713695 |
|---|---|
| Provider Enumeration Date | 07/08/2005 |
| Last Update Date | 09/15/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093713695 | NPI | - | NPPES |
| 343950A | Medicaid | NC | |
| 0171A | Other | NC | BCBSNC |
| 343950C | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 25053 (North Carolina) | Primary |
| 208000000X | Pediatrics | 25053 (North Carolina) | Secondary |
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