Provider Demographics
NPI:1962814400
Name:GRAYSON, JILLIANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JILLIANNE
Middle Name:
Last Name:GRAYSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 COMMERCE CENTRE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5804
Mailing Address - Country:US
Mailing Address - Phone:980-202-2490
Mailing Address - Fax:732-605-5910
Practice Address - Street 1:107 COMMERCE CENTRE DR STE 201
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5804
Practice Address - Country:US
Practice Address - Phone:980-202-2490
Practice Address - Fax:732-605-5910
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2022-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1347822084P0800X
NC2021-026872084P0804X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry