Provider Demographics
NPI:1467760645
Name:GRAYSON, RALPH LEWIS (CPO)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:LEWIS
Last Name:GRAYSON
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4865 SUMMIT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-5008
Mailing Address - Country:US
Mailing Address - Phone:229-259-9623
Mailing Address - Fax:
Practice Address - Street 1:4865 SUMMIT RIDGE RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-5008
Practice Address - Country:US
Practice Address - Phone:229-259-9623
Practice Address - Fax:229-560-9936
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACPO 611744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management