Provider Demographics
NPI:1306506241
Name:ROWE, GRADY ROSS (PA)
Entity type:Individual
Prefix:MR
First Name:GRADY
Middle Name:ROSS
Last Name:ROWE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1474 AMY AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-7037
Mailing Address - Country:US
Mailing Address - Phone:865-340-7912
Mailing Address - Fax:
Practice Address - Street 1:62 MEDICAL DR STE A
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:TN
Practice Address - Zip Code:37096-3305
Practice Address - Country:US
Practice Address - Phone:315-892-6009
Practice Address - Fax:931-589-2602
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2024-10-30
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant