Provider Demographics
NPI:1902352172
Name:GRAYSON, JAY PATRICK (CSFA, SA-C)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:PATRICK
Last Name:GRAYSON
Suffix:
Gender:M
Credentials:CSFA, SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 802
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37352-0802
Mailing Address - Country:US
Mailing Address - Phone:931-205-2753
Mailing Address - Fax:
Practice Address - Street 1:114 E MCGUIRE ST
Practice Address - Street 2:
Practice Address - City:BELL BUCKLE
Practice Address - State:TN
Practice Address - Zip Code:37020-6052
Practice Address - Country:US
Practice Address - Phone:931-205-2753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13-456246ZC0007X
TN103596246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant