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General NPI Number Information
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NPI Number | 1275357378
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Entity Type | Organization
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Legal Business Name | GRAYBEAL ORTHOPEDIC LLC
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 127 WILLOW DR STE F
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City | WHITESBURG
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State | KY
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Zip | 41858
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Country | US
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Telephone | 606-331-3188
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Fax | 606-203-2780
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Provider Business Mailing Address
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Address Line | 107 E MYRTLE AVE
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City | JOHNSON CITY
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State | TN
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Zip | 37601-4631
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Country | US
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Telephone | 423-975-9884
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Fax | 423-975-6678
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Authorized Official
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Title or Position | OWNER
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Name | MR. ADAM LEE FANN
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Credential | CPO
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Telephone | 423-975-9884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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