Provider Demographics
NPI:1932220720
Name:FAMILY DOCTORS OF OAK RIDGE, PC
Entity type:Organization
Organization Name:FAMILY DOCTORS OF OAK RIDGE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRABENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-482-1692
Mailing Address - Street 1:400 LABORATORY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6808
Mailing Address - Country:US
Mailing Address - Phone:865-482-1692
Mailing Address - Fax:865-482-4070
Practice Address - Street 1:400 LABORATORY RD STE 101
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6808
Practice Address - Country:US
Practice Address - Phone:865-482-1692
Practice Address - Fax:865-482-4070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3720017Medicare ID - Type Unspecified