Grace Pediatric Clinic, P.a.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

9800405 Issued in NC

Legal business name

GRACE PEDIATRIC CLINIC, P.A.

Practice address

2401 Tuckaseegee Rd
Charlotte, NC 28208-4058

Phone

(704) 409-3000

Fax

(704) 409-2382

NPI assigned

Jan 4, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Julius Tokunboh, M.D.NPI 1952410110

Title

Medical Director

Phone

(709) 409-3000

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Julius Kehinde Tokunboh, M.D.

  • Internal Medicine Physician
  • Concord, NC
  • NPI 1952410110
  NPD Authorized official
• Jayla Marie Caffey

  • Physician Assistant
  • Charlotte, NC
  • NPI 1891496824
  NPD (past)
• Eden Asefaw Ghebresilasie, PA

  • Physician Assistant
  • North Miami Beach, FL
  • NPI 1164591400
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1447307384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 TUCKASEEGEE RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282084058",
            "telephone_number": "704-409-3000",
            "fax_number": "704-409-2382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 TUCKASEEGEE RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282084058",
            "telephone_number": "704-409-3000",
            "fax_number": "704-409-2382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE PEDIATRIC CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TOKUNBOH",
        "authorized_official_first_name": "JULIUS",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "709-409-3000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "9800405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891359N",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Grace Childs Family Services
• Grace Family Care, PC
• Grace Mar Training and Employment Services LLC
• Grace Medical Clinics, PA (Pinnacle Mecial Clinis, PA)
• Grace Mercy Mobile Urgent Care Services PLLC
• Grace to You LLC (Grace to you Home Health Care)
• Gracefield Home Care of North Carolina LLC
• Graceful Aging Care
• Graceful Journey LLC
• Graceful Village

• Pediatrics Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.