MEDICARE: GRAYSON H WHEATLEY III MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	33217	AZ
2	208600000X	Surgery Physician	MD448565	PA
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	54798	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00219385	OTHER	AZ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	54798	OTHER	TN	TN MEDICAL LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	WCSKQ	OTHER	AZ	SUN HEALTH GROUP #

General Provider Information

NPI Number	:	1083615934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRAYSON H WHEATLEY III MD

Provider Business Mailing Address
First Line	:	2400 PATTERSON ST
Second Line	:	SUITE 307
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1562
Country	:	US
Telephone Number	:	615-342-6900
Fax Number	:	615-342-6899

Provider Business Practice Location Address
First Line	:	2400 PATTERSON ST
Second Line	:	SUITE 307
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1562
Country	:	US
Telephone Number	:	615-342-6900
Fax Number	:	615-342-6899

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	10/03/2016

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Directions to “ GRAYSON H WHEATLEY III MD” Practice Location

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