Healthcare Provider Details

I. General information

NPI: 1215771027
Provider Name (Legal Business Name): GRAYSON NORTHCUTT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WRENN AVE
NEW PARIS OH
45347-1262
US

IV. Provider business mailing address

400 WRENN AVE
NEW PARIS OH
45347-1262
US

V. Phone/Fax

Practice location:
  • Phone: 512-633-6242
  • Fax:
Mailing address:
  • Phone: 512-633-6242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: