Healthcare Provider Details

I. General information

NPI: 1275357378
Provider Name (Legal Business Name): GRAYBEAL ORTHOPEDIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 WILLOW DR STE F
MAYKING KY
41837-8303
US

IV. Provider business mailing address

107 E MYRTLE AVE
JOHNSON CITY TN
37601-4631
US

V. Phone/Fax

Practice location:
  • Phone: 606-331-3188
  • Fax: 606-203-2780
Mailing address:
  • Phone: 423-975-9884
  • Fax: 423-975-6678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. ADAM LEE FANN
Title or Position: OWNER
Credential: CPO
Phone: 423-975-9884