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General NPI Number Information
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NPI Number | 1033464060
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Entity Type | Organization
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Legal Business Name | GRAYSON HIGHLANDS CLINIC CORP
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Dates
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Enumeration Date | 07/16/2012
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Last Update Date | 07/16/2012
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Provider Practice Location Address
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Address Line | 6436 TROUTDALE HWY
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City | TROUTDALE
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State | VA
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Zip | 24378-2023
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Country | US
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Telephone | 276-783-1827
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Fax | 276-783-2879
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Provider Business Mailing Address
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Address Line | 6436 TROUTDALE HWY
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City | TROUTDALE
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State | VA
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Zip | 24378-2023
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Country | US
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Telephone | 276-783-1827
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Fax | 276-783-2879
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Authorized Official
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Title or Position | OWNER
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Name | JANE G SAGE
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Credential | NP
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Telephone | 276-579-2128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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