Provider Demographics
NPI:1972509297
Name:ANDERSON, NICHOLAS GRAY (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:GRAY
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9050 EXECUTIVE PARK DR STE 202A
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4670
Mailing Address - Country:US
Mailing Address - Phone:423-756-1512
Mailing Address - Fax:865-934-3884
Practice Address - Street 1:1124 E WEISGARBER RD
Practice Address - Street 2:STE 207
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2686
Practice Address - Country:US
Practice Address - Phone:865-588-0811
Practice Address - Fax:865-584-2153
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2022-06-30
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Provider Licenses
StateLicense IDTaxonomies
TN39535207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00242478OtherRAILROAD MEDICARE
TN3329764Medicaid
VA010157684Medicaid
VA010157684Medicaid
TN3329764Medicaid