Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 11861 | NC |
NPI | 1366060386 |
---|---|
Provider Name | Dr. Makayla Brooke Gresham |
First Address | Chapel Hill, NC 27517-7366 |
Second Address | Chapel Hill, NC 27599 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2020 |
Last Update Date | 07/07/2020 |