Basic Information
| Provider Information | |||||||||
| NPI: | 1194883538 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRISSO | ||||||||
| FirstName: | GREG | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 WESTCHESTER DR | ||||||||
| Address2: | STE 850 | ||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272627254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368022400 | ||||||||
| FaxNumber: | 3368022001 | ||||||||
| Practice Location | |||||||||
| Address1: | 327 ROCK CRUSHER ROAD | ||||||||
| Address2: | |||||||||
| City: | ASHEBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366365546 | ||||||||
| FaxNumber: | 3366365145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 07/06/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 562234742 | NC | N | Other Service Providers | Specialist | 207R00000X | 9900516 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 31491 | 01 | NC | PARTNERS | OTHER | 891273 | 01 | NC | MAMSI HMO | OTHER | P00454351 | 01 | NC | RR MEDICARE | OTHER | 891206W | 05 | NC | MEDICAID | 1206W | 01 | NC | BLUE CROSS | OTHER | 0407877 | 01 | NC | UNITED HEALTH CARE | OTHER | 86827 | 01 | NC | MEDCOST | OTHER | 291273 | 01 | NC | MAMSI - PPO | OTHER | 4997222005 | 01 | NC | CIGNA | OTHER |