Provider Demographics
NPI:1124520440
Name:GRAVELY, GRAYSON MASSEY (PA-C)
Entity type:Individual
Prefix:
First Name:GRAYSON
Middle Name:MASSEY
Last Name:GRAVELY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-1177
Mailing Address - Country:US
Mailing Address - Phone:919-894-1740
Mailing Address - Fax:919-894-2701
Practice Address - Street 1:1 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-1177
Practice Address - Country:US
Practice Address - Phone:919-894-1740
Practice Address - Fax:919-894-2701
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07797363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant