Provider Demographics
NPI:1720221815
Name:CHASE GREAVES, AYANA (MD)
Entity Type:Individual
Prefix:
First Name:AYANA
Middle Name:
Last Name:CHASE GREAVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AYANA
Other - Middle Name:
Other - Last Name:CHASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4548 EMPIRE CT STE 100-A
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-1939
Mailing Address - Country:US
Mailing Address - Phone:540-373-2244
Mailing Address - Fax:
Practice Address - Street 1:4548 EMPIRE CT
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-1939
Practice Address - Country:US
Practice Address - Phone:540-373-2244
Practice Address - Fax:404-616-0787
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101276595208C00000X
GA071673208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0031269932BMedicaid
GA0031269932CMedicaid