Provider Demographics
NPI:1003848722
Name:GRACY, RONALD A II (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:GRACY
Suffix:II
Gender:M
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:PO BOX 634706
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:941 SPRING CREEK RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-3909
Practice Address - Country:US
Practice Address - Phone:423-894-7870
Practice Address - Fax:865-539-8008
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD24850207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3036300OtherBCBS OF TENNESSEE
TN3079844Medicaid
TNP00217707OtherRAILROAD MEDICARE
TN3079849Medicaid
TN4150069OtherBLUE CROSS
GA000593568BMedicaid
GA000593568BMedicaid
TNP00217707OtherRAILROAD MEDICARE
TNE87862Medicare UPIN