Provider Demographics
NPI:1124313556
Name:MENARD, GRAYSON WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:GRAYSON
Middle Name:WILLIAM
Last Name:MENARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT RD NE BLDG 93
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-949-5183
Mailing Address - Fax:
Practice Address - Street 1:701 UNIVERSITY BLVD E STE 606
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-7411
Practice Address - Country:US
Practice Address - Phone:205-752-2501
Practice Address - Fax:205-759-5874
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL36866208600000X
TN56149208600000X
GA86092208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAINTERNMedicaid
AL36866Medicaid
TNQ032754Medicaid