1245886837 NPI number — JONATHAN GRAVLEE OD

Table of content: JONATHAN GRAVLEE OD (NPI 1245886837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245886837 NPI number — JONATHAN GRAVLEE OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAVLEE
Provider First Name:
JONATHAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245886837
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8614 WESTWOOD CENTER DR FL 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIENNA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22182-2442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-847-8899
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1686 MONTGOMERY HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOOVER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35216-4906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-979-2020
Provider Business Practice Location Address Fax Number:
205-978-6487
Provider Enumeration Date:
08/10/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  S-E25-TA-B50 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com