Provider Demographics
NPI:1699803239
Name:GRAYSON, JACKIE (MD)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:GRAYSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BRENTSHIRE SQ
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2203
Mailing Address - Country:US
Mailing Address - Phone:731-664-0994
Mailing Address - Fax:731-664-0866
Practice Address - Street 1:1301 PRIMACY PKWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0213
Practice Address - Country:US
Practice Address - Phone:901-448-0275
Practice Address - Fax:901-448-0404
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program