Provider Demographics
NPI:1932381753
Name:DEBRA A. GRAYSON, D.O., INC.
Entity Type:Organization
Organization Name:DEBRA A. GRAYSON, D.O., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-575-6270
Mailing Address - Street 1:4677 E. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-3160
Mailing Address - Country:US
Mailing Address - Phone:614-575-6270
Mailing Address - Fax:614-575-6282
Practice Address - Street 1:4677 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-3160
Practice Address - Country:US
Practice Address - Phone:614-575-6270
Practice Address - Fax:614-575-6282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-004095-G207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0716354Medicaid
OHA16503Medicare UPIN
OH0716354Medicaid
OH0585391Medicare PIN