Provider Demographics
NPI:1164934360
Name:STONE, GRADY W JR
Entity Type:Individual
Prefix:MR
First Name:GRADY
Middle Name:W
Last Name:STONE
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 1:2011 HIGHWAY 280 BYP
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-3624
Mailing Address - Country:US
Mailing Address - Phone:334-480-4015
Mailing Address - Fax:334-448-9918
Practice Address - Street 1:2011 HIGHWAY 280 BYP
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-3624
Practice Address - Country:US
Practice Address - Phone:334-480-4015
Practice Address - Fax:334-448-9918
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-27
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL138616156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty