Basic Information
Provider Information
NPI: 1487609319
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCGRATH
FirstName: JAMES
MiddleName: G
NamePrefix: MR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 744786
Address2:  
City: ATLANTA
State: GA
PostalCode: 303744786
CountryCode: US
TelephoneNumber: 7048342450
FaxNumber: 7046715331
Practice Location
Address1: 2711 X RAY DR STE 3701
Address2:  
City: GASTONIA
State: NC
PostalCode: 28054
CountryCode: US
TelephoneNumber: 9808349600
FaxNumber: 9808349605
Other Information
ProviderEnumerationDate: 05/22/2006
LastUpdateDate: 11/06/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003X2005-00323NCY Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

ID Information
IDTypeStateIssuerDescription
1391W01NCBCBSOTHER
148760931905NC MEDICAID


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