Organization
GRACE INTERNAL MEDICINE, LLC
Active
Parent organization
GRACE INTERNAL MEDICINE, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
GRACE INTERNAL MEDICINE, LLC
Authorized official
MRS. WHITNEY DIANA DAVIS PA-C (PHYSICIAN ASSISTANT/OWNER)
(423) 282-2700
Entity
Organization
Contact information
Practice address
2514 WESLEY ST, SUITE 102, JOHNSON CITY, TN 37601-1764
(423) 282-2700
(423) 282-2802
Mailing address
2514 WESLEY ST, SUITE 102, JOHNSON CITY, TN 37601-1764
(423) 282-2700
(423) 282-2802
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2497
TN
Other
Enumeration date
10/21/2016
Last updated
10/21/2016
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