Provider Demographics
NPI:1356344725
Name:GRISOLANO, JAMES M JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:GRISOLANO
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:999 GUARDIAN WAY
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-1722
Mailing Address - Country:US
Mailing Address - Phone:931-650-4100
Mailing Address - Fax:931-650-4101
Practice Address - Street 1:999 GUARDIAN WAY
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1722
Practice Address - Country:US
Practice Address - Phone:931-650-4100
Practice Address - Fax:931-650-4101
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2023-01-03
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000016505207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00130863OtherRAILROAD MEDICARE
TNP00130863OtherRAILROAD MEDICARE
TNA98164Medicare UPIN