Provider Demographics
NPI:1720029275
Name:GRAYSON, PATRICK CARL (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:CARL
Last Name:GRAYSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WATERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-8842
Mailing Address - Country:US
Mailing Address - Phone:865-406-0802
Mailing Address - Fax:
Practice Address - Street 1:1425 S MOORE RD STE E
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-2836
Practice Address - Country:US
Practice Address - Phone:865-406-0802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36478207Q00000X, 207P00000X
LAMD.13301R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1561100Medicaid
VA010256682Medicaid
TNP00255392OtherRAILROAD MEDICARE
TN3875615Medicaid
TN4067317OtherBCBS OF TENNESSEE
TNH08129Medicare UPIN
TN4067317OtherBCBS OF TENNESSEE
TN3875615Medicaid