Healthcare Provider Details

I. General information

NPI: 1730491317
Provider Name (Legal Business Name): STOYAN GRAKOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 SPRING CREEK RD
CHATTANOOGA TN
37412-3909
US

IV. Provider business mailing address

210 CORNELIA ST STE 405
PLATTSBURGH NY
12901-2318
US

V. Phone/Fax

Practice location:
  • Phone: 423-855-3691
  • Fax:
Mailing address:
  • Phone: 518-314-3614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number262418
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number57078
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number57078
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: