Individual
MR. JERALD DEAN GRISSOM III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
306 LIBERTY VIEW LN, LYNCHBURG, VA 24502-2291
(434) 592-6400
Mailing address
2600 WEEPING WILLOW DR APT B, LYNCHBURG, VA 24501-3938
(919) 709-5694
Taxonomy
Speciality
Code
Description
License number
State
146M00000X
Intermediate Emergency Medical Technician
C202504081
VA
146M00000X
Intermediate Emergency Medical Technician
P530638
NC
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/14/2025
Last updated
07/30/2025
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