Provider Demographics
NPI:1619867801
Name:GRISSOM, DEVIN
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:
Last Name:GRISSOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 QUINCY CIR
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-6506
Mailing Address - Country:US
Mailing Address - Phone:818-406-9750
Mailing Address - Fax:
Practice Address - Street 1:431 QUINCY CIR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-6506
Practice Address - Country:US
Practice Address - Phone:818-406-9750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care