MEDICARE: GRACE PEDIATRICS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner
2	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1467781690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE PEDIATRICS PLLC

Provider Business Mailing Address
First Line	:	1335 ROCK SPRINGS ROAD
Second Line	:
City	:	SMYRNA
State	:	TN
Zip	:	37167-6108
Country	:	US
Telephone Number	:	615-459-5252
Fax Number	:	615-459-5232

Provider Business Practice Location Address
First Line	:	1335 ROCK SPRINGS ROAD
Second Line	:
City	:	SMYRNA
State	:	TN
Zip	:	37167-6108
Country	:	US
Telephone Number	:	615-459-5252
Fax Number	:	615-459-5232

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	MARK DAVID HUGHES
Credential	:	M.D.
Telephone Number	:	615-459-5252

Provider Enumeration Date	:	12/17/2009
Last Update Date	:	11/13/2025

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