Healthcare Provider Details

I. General information

NPI: 1083273247
Provider Name (Legal Business Name): GRAYSON TUCKER HUNLEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4714 PAPERMILL DR
KNOXVILLE TN
37909-1972
US

IV. Provider business mailing address

7128 ROYAL SPRINGS BLVD
KNOXVILLE TN
37918-8300
US

V. Phone/Fax

Practice location:
  • Phone: 865-588-4472
  • Fax:
Mailing address:
  • Phone: 865-368-8794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11021
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: