Organization
GRAYBEAL ORTHOPEDIC, LLC
Active
Other names
Anchor Brace and Limb
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ADAM FANN CPO (OWNER)
(423) 975-9884
Entity
Organization
Contact information
Practice address
107 E MYRTLE AVE, JOHNSON CITY, TN 37601-4631
(423) 975-9884
(423) 975-6678
Mailing address
107 E MYRTLE AVE, JOHNSON CITY, TN 37601-4631
(423) 975-9884
(423) 975-6678
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003035088
BCBS OF TN
TN
05
—
1452173
—
TN
Enumeration date
07/20/2006
Last updated
05/27/2020
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