Provider Demographics
NPI:1932432416
Name:GRISSOM, SARAH E (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:GRISSOM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 DAYTON BLVD
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:TN
Mailing Address - Zip Code:37415-7156
Mailing Address - Country:US
Mailing Address - Phone:423-499-7710
Mailing Address - Fax:423-499-7711
Practice Address - Street 1:4101 DAYTON BLVD
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:TN
Practice Address - Zip Code:37415-7156
Practice Address - Country:US
Practice Address - Phone:423-499-7710
Practice Address - Fax:423-499-7711
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016538363AM0700X
NC0010-01972363AM0700X
TN3294363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical