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Individual

JERALD DEAN GRISSOM JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-8898
(336) 716-7277
Mailing address
2271 N NC 119, MEBANE, NC 27302
(336) 380-7277
(336) 716-7277

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-04281
NC

Other

Enumeration date
04/11/2006
Last updated
02/17/2014
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