Provider Demographics
NPI:1467781690
Name:GRACE PEDIATRICS PLLC
Entity Type:Organization
Organization Name:GRACE PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-459-5252
Mailing Address - Street 1:1335 ROCK SPRINGS ROAD
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6108
Mailing Address - Country:US
Mailing Address - Phone:615-459-5252
Mailing Address - Fax:615-459-5232
Practice Address - Street 1:1335 ROCK SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6108
Practice Address - Country:US
Practice Address - Phone:615-459-5252
Practice Address - Fax:615-459-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty