Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 39602 | NC |
N | 111NI0900X | Internist | 39602 | NC |
Y | 207RH0000X | Hematologist | 90308 | NC |
N | 207RH0003X | Hematology & Oncology | 90308 | NC |
NPI | 1366495707 |
---|---|
Provider Name | Dr. James Mitchell Granfortuna |
First Address | Atlanta, GA 30384-5633 |
Second Address | Greensboro, NC 27403-1118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 21/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36721 | BCBS NC (01) | NC |
37875 | MEDCOST (01) | NC |
5644 | MEDICARE PARTNERS (01) | NC |
5994101 | AETNA (01) | NC |
8936721 | (05) | NC |
D20944 | (02) |