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General NPI Number Information
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NPI Number | 1871026070
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Entity Type | Individual
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Provider Name | GRAYSON EVAN MCCONNELL MD
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Gender | Male
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Dates
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Enumeration Date | 04/05/2017
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 1720 GUNBARREL RD
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City | CHATTANOOGA
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State | TN
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Zip | 37421-4144
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Country | US
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Telephone | 423-778-8610
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Fax | 423-778-8611
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Provider Business Mailing Address
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Address Line | 132 LYNDA DR
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City | CHATTANOOGA
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State | TN
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Zip | 37405-1316
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 60932
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License Number State | TN
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