Active NPI
Walter M. Grayson Jr., D.D.S.
- General Practice Dentistry
- Chamblee, GA
National Provider Identifier
1194932855
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 8862
- Practice address
- 3640 Chamblee Tucker Rd
Chamblee, GA 30341-4418 - Phone
- (770) 938-0232
- NPI assigned
- May 16, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8862 | GA | Primary |
Addresses
Primary practice location
3640 Chamblee Tucker Rd
Chamblee, GA 30341-4418
Mailing address
2027 Springview TRL
Tucker, GA 30084-2448
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881323 | Other | GA | UNITED CONCORDIA ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8862 | GA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Henry J. Hudson and Associates | General Practice | Past | Accepting new patients |
| Lida Paez, DMD, LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Atlanta, GA
- NPI 1386170363
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1194932855",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2027 SPRINGVIEW TRL",
"city": "TUCKER",
"state": "GA",
"postal_code": "300842448"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3640 CHAMBLEE TUCKER RD",
"city": "CHAMBLEE",
"state": "GA",
"postal_code": "303414418",
"telephone_number": "770-938-0232"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAYSON",
"first_name": "WALTER",
"middle_name": "M.",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "8862",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA ID",
"identifier": "1881323",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chamblee, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.