Provider Demographics
NPI:1114165370
Name:GRATTON, SKYE FOST (PA)
Entity Type:Individual
Prefix:
First Name:SKYE
Middle Name:FOST
Last Name:GRATTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 BOUNDARY ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4268
Mailing Address - Country:US
Mailing Address - Phone:865-660-7593
Mailing Address - Fax:
Practice Address - Street 1:1200 CORPORATE DR STE 105
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-2942
Practice Address - Country:US
Practice Address - Phone:205-995-7980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1680363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant