Healthcare Provider Details

I. General information

NPI: 1710735220
Provider Name (Legal Business Name): GRACE PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 RESERVE BLVD STE 200
SPRING HILL TN
37174-3101
US

IV. Provider business mailing address

1335 ROCK SPRINGS RD
SMYRNA TN
37167-6108
US

V. Phone/Fax

Practice location:
  • Phone: 615-302-1279
  • Fax: 615-302-5279
Mailing address:
  • Phone: 615-459-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ANGELA STOUT
Title or Position: OFFICE MANAGER
Credential:
Phone: 615-459-5252