Provider Demographics
NPI:1922683846
Name:PAR, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:PAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 N HIGHLAND AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2494
Mailing Address - Country:US
Mailing Address - Phone:615-396-6454
Mailing Address - Fax:
Practice Address - Street 1:920 MADISON AVENUE SUITE 447
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-5253
Practice Address - Country:US
Practice Address - Phone:615-396-6453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program