Basic Information
| Provider Information | |||||||||
| NPI: | 1053708891 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BYRD | ||||||||
| FirstName: | GRAYLAN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | ATC, PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5307 BENTGRASS RUN DR | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282696131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362622720 | ||||||||
| FaxNumber: | 7046390785 | ||||||||
| Practice Location | |||||||||
| Address1: | 810 MITCHELL AVE | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281446253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042165633 | ||||||||
| FaxNumber: | 7046390785 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2015 | ||||||||
| LastUpdateDate: | 10/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0010-05613 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.