Basic Information
| Provider Information | |||||||||
| NPI: | 1366495707 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRANFORTUNA | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | MITCHELL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 405633 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303845633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368323677 | ||||||||
| FaxNumber: | 3368323681 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 N ELAM AVE | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274031118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368321100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 09/21/2010 | ||||||||
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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 | 207R00000X | 39602 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | 90308 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0000X | 90308 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology |
ID Information
| ID | Type | State | Issuer | Description | 8936721 | 05 | NC | MEDICAID | 37875 | 01 | NC | MEDCOST | OTHER | 5644 | 01 | NC | MEDICARE PARTNERS | OTHER | 5994101 | 01 | NC | AETNA | OTHER | 36721 | 01 | NC | BCBS NC | OTHER |