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General NPI Number Information
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NPI Number | 1336939628
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Entity Type | Individual
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Provider Name | GRAYSON YORK
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Gender | Male
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Dates
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Enumeration Date | 05/09/2025
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 21 WESTBROOK BLVD
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City | ELLIJAY
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State | GA
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Zip | 30536
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Country | US
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Telephone | 706-635-2218
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Fax |
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Provider Business Mailing Address
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Address Line | 448 CENTRAL WAY
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City | CHATSWORTH
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State | GA
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Zip | 30705-7327
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN123859
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License Number State | GA
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