Healthcare Provider Details

I. General information

NPI: 1699394817
Provider Name (Legal Business Name): JAMES W GRAYSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 W WHITES BRIDGE AVE
FRESNO CA
93706-1225
US

IV. Provider business mailing address

1235 E ST
FRESNO CA
93706-2024
US

V. Phone/Fax

Practice location:
  • Phone: 559-264-5096
  • Fax: 559-223-2898
Mailing address:
  • Phone: 559-268-6261
  • Fax: 559-268-7518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: