Provider Demographics
NPI:1699423020
Name:SESSOMS, GRADY JR
Entity type:Individual
Prefix:MR
First Name:GRADY
Middle Name:
Last Name:SESSOMS
Suffix:JR
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 1:3007 E BOUNDARY TER STE 109
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-3933
Mailing Address - Country:US
Mailing Address - Phone:804-988-6294
Mailing Address - Fax:
Practice Address - Street 1:3007 E BOUNDARY TER STE 109
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-3933
Practice Address - Country:US
Practice Address - Phone:804-988-6294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-221959253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA87-2662982OtherNON-MEDICAL