Provider Demographics
NPI:1275357378
Name:GRAYBEAL ORTHOPEDIC LLC
Entity type:Organization
Organization Name:GRAYBEAL ORTHOPEDIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FANN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:423-975-9884
Mailing Address - Street 1:107 E MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-4631
Mailing Address - Country:US
Mailing Address - Phone:423-975-9884
Mailing Address - Fax:423-975-6678
Practice Address - Street 1:127 WILLOW DR
Practice Address - Street 2:STE F
Practice Address - City:WHITESBURG
Practice Address - State:KY
Practice Address - Zip Code:41858
Practice Address - Country:US
Practice Address - Phone:606-331-3188
Practice Address - Fax:606-203-2780
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRAYBEAL ORTHOPEDIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-14
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier