Provider Demographics
NPI:1124241997
Name:GRISSOM, HILARY C (MD)
Entity type:Individual
Prefix:MRS
First Name:HILARY
Middle Name:C
Last Name:GRISSOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:HILARY
Other - Middle Name:C
Other - Last Name:GRISSOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:668 SKYLINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301
Mailing Address - Country:US
Mailing Address - Phone:731-424-2414
Mailing Address - Fax:731-424-4444
Practice Address - Street 1:668 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301
Practice Address - Country:US
Practice Address - Phone:731-424-2414
Practice Address - Fax:731-424-4444
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43415207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology