Provider Demographics
NPI:1851953137
Name:GRAVELY, JASON O'NEAL
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:O'NEAL
Last Name:GRAVELY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 TURNER ASHBY RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-0638
Mailing Address - Country:US
Mailing Address - Phone:276-732-6030
Mailing Address - Fax:276-336-3029
Practice Address - Street 1:344 TURNER ASHBY RD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-0638
Practice Address - Country:US
Practice Address - Phone:276-732-6030
Practice Address - Fax:276-336-3029
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)