Provider Demographics
NPI:1396412458
Name:LOVELESS, GRAYSON MYERS (NP)
Entity Type:Individual
Prefix:
First Name:GRAYSON
Middle Name:MYERS
Last Name:LOVELESS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 SHADOWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-2256
Mailing Address - Country:US
Mailing Address - Phone:817-983-6117
Mailing Address - Fax:
Practice Address - Street 1:1100 PEACHTREE ST NE STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-4829
Practice Address - Country:US
Practice Address - Phone:404-445-5304
Practice Address - Fax:404-445-5173
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN265383207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine