Provider Demographics
NPI:1326138470
Name:GRIGSBY, HOLLY CHARLENE (MD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:CHARLENE
Last Name:GRIGSBY
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 1:2204 PAVILION DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4657
Mailing Address - Country:US
Mailing Address - Phone:423-378-1500
Mailing Address - Fax:423-378-1520
Practice Address - Street 1:2204 PAVILION DR
Practice Address - Street 2:SUITE 110
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4657
Practice Address - Country:US
Practice Address - Phone:423-378-1500
Practice Address - Fax:423-378-1520
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD42820207Q00000X
VA0101242431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I084818Medicare PIN