Provider Demographics
NPI:1477546885
Name:GRACY, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:GRACY
Suffix:
Gender:M
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:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401-0430
Mailing Address - Country:US
Mailing Address - Phone:423-826-8585
Mailing Address - Fax:423-826-8588
Practice Address - Street 1:7011 SHALLOWFORD RD
Practice Address - Street 2:SUITE 106
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6727
Practice Address - Country:US
Practice Address - Phone:423-826-8585
Practice Address - Fax:423-826-8588
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27446207X00000X
GA034145207X00000X
VA0101271210207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00470115CMedicaid
TN3806724Medicare PIN
E85242Medicare UPIN
20BDCSQMedicare ID - Type Unspecified