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General NPI Number Information
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NPI Number | 1215944988
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Entity Type | Organization
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Legal Business Name | S. GRAYSON EDDY, D.D.S.,P.C.
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 08/31/2007
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Provider Practice Location Address
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Address Line | 3221 W GOVERNOR JOHN SEVIER HWY
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City | KNOXVILLE
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State | TN
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Zip | 37920-5540
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Country | US
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Telephone | 865-579-3000
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Fax | 865-579-3056
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Provider Business Mailing Address
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Address Line | 3221 W GOVERNOR JOHN SEVIER HWY
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City | KNOXVILLE
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State | TN
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Zip | 37920-5540
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Country | US
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Telephone | 865-579-3000
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Fax | 865-579-3056
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SAMUEL GRAYSON EDDY JR.
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Credential | D.D.S.
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Telephone | 865-579-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DS 1916
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License Number State | TN
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