MEDICARE: DEBRA A. GRAYSON, D.O., INC.

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	207Q00000X	Family Medicine Physician	34-004095-G	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932381753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBRA A. GRAYSON, D.O., INC.

Provider Business Mailing Address
First Line	:	4677 E. MAIN STREET
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-3160
Country	:	US
Telephone Number	:	614-575-6270
Fax Number	:	614-575-6282

Provider Business Practice Location Address
First Line	:	4677 E MAIN ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-3160
Country	:	US
Telephone Number	:	614-575-6270
Fax Number	:	614-575-6282

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	TRICIA L SMITH
Credential	:
Telephone Number	:	614-575-6270

Provider Enumeration Date	:	12/04/2007
Last Update Date	:	02/13/2008

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