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NPI Code Detail

MEDICARE: GRACE BALSAM

MEDICARE: GRACE BALSAM
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
1390200000XStudent in an Organized Health Care Education/Training ProgramTN

General Provider Information

NPI Number : 1861334971
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE BALSAM
Provider Business Mailing Address
First Line : 4224 WAYMAR DR
Second Line :
City : MEMPHIS
State : TN
Zip : 38117-2342
Country : US
Telephone Number : 901-734-8000
Fax Number :
Provider Business Practice Location Address
First Line : 302 TYSON AVE STE B
Second Line :
City : PARIS
State : TN
Zip : 38242-4555
Country : US
Telephone Number : 731-407-7650
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2026
Last Update Date : 04/07/2026

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Directions to “ GRACE BALSAM ” Practice Location

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