Provider Demographics
NPI:1992988463
Name:TERRY GRAYBEAL
Entity type:Organization
Organization Name:TERRY GRAYBEAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAYBEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-638-2670
Mailing Address - Street 1:504 JUSTIS DR
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4287
Mailing Address - Country:US
Mailing Address - Phone:423-638-2670
Mailing Address - Fax:423-638-6592
Practice Address - Street 1:504 JUSTIS DR
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4287
Practice Address - Country:US
Practice Address - Phone:423-638-2670
Practice Address - Fax:423-638-6592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0460275332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3546804Medicaid
TN48336OtherBCBS
TN0425720001Medicare NSC