Provider Demographics
NPI:1508073883
Name:GRAYLINE CLINICAL DRUG TRIALS
Entity Type:Organization
Organization Name:GRAYLINE CLINICAL DRUG TRIALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:R
Authorized Official - Last Name:TOMLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-322-1131
Mailing Address - Street 1:3300 SEYMOUR HWY
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-1608
Mailing Address - Country:US
Mailing Address - Phone:940-322-1131
Mailing Address - Fax:940-322-4953
Practice Address - Street 1:3300 SEYMOUR HWY
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76309-1608
Practice Address - Country:US
Practice Address - Phone:940-322-1131
Practice Address - Fax:940-322-4953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC6537103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty