Provider Demographics
NPI:1215771027
Name:NORTHCUTT, GRAYSON
Entity type:Individual
Prefix:
First Name:GRAYSON
Middle Name:
Last Name:NORTHCUTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 WRENN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PARIS
Mailing Address - State:OH
Mailing Address - Zip Code:45347-1262
Mailing Address - Country:US
Mailing Address - Phone:512-633-6242
Mailing Address - Fax:
Practice Address - Street 1:400 WRENN AVE
Practice Address - Street 2:
Practice Address - City:NEW PARIS
Practice Address - State:OH
Practice Address - Zip Code:45347-1262
Practice Address - Country:US
Practice Address - Phone:512-633-6242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS