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General NPI Number Information
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NPI Number | 1295434793
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Entity Type | Organization
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Legal Business Name | GRACE POINT PLLC
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Dates
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Enumeration Date | 02/23/2023
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Last Update Date | 02/23/2023
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Provider Practice Location Address
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Address Line | 2012 CHILHOWEE MEDICAL PARK
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City | MARYVILLE
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State | TN
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Zip | 37804-5285
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Country | US
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Telephone | 606-813-1979
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Fax | 606-363-0789
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Provider Business Mailing Address
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Address Line | 253 REYNOLDS RD
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City | KEAVY
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State | KY
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Zip | 40737-2834
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Country | US
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Telephone | 606-813-1979
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF FINANCE
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Name | MR. DAWAYNE DOUGLAS CANTRELL
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Credential |
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Telephone | 606-813-1979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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