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General NPI Number Information
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NPI Number | 1154419331
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Entity Type | Organization
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Legal Business Name | GRADY ORTHOPAEDICS, LLC
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 480 FLOYD RD
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City | SPARTANBURG
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State | SC
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Zip | 29307-1518
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Country | US
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Telephone | 864-582-2115
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Fax | 864-582-2117
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Provider Business Mailing Address
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Address Line | 480 FLOYD RD
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City | SPARTANBURG
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State | SC
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Zip | 29307-1518
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Country | US
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Telephone | 864-582-2115
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Fax | 864-582-2117
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Authorized Official
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Title or Position | SURGEON
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Name | WALTER GRADY
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Credential | D.O.
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Telephone | 864-582-2115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 504
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License Number State | SC
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