Individual provider Active NPI

Grayson L Landers, PA-C

  • Physician Assistant
  • Chattanooga, TN
National Provider Identifier
1629889290
Registry record updated May 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2525 Desales Ave
Chattanooga, TN 37404-1161
NPI assigned
Jan 14, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 27, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

2525 Desales Ave
Chattanooga, TN 37404-1161

Mailing address

2525 Desales Ave
Chattanooga, TN 37404-1161
Phone (423) 495-2525

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250604002461 TN Practitioner - Physician Assistant 8820507411 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Tennessee, HSC, College of Medicine, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Health Partners Foundation IncGroup PAC ID 8022919570, 458 clinicians

Practice addresses (Care Compare)

2525 Desales Ave
Chattanooga, TN 37404-1161
Phone (423) 492-4734

5600 Brainerd Rd
Suite 500
Chattanooga, TN 37411-5371
Phone (423) 414-3586

Hospital & facility affiliations

  • Memorial Healthcare System, Inc Hospital, Chattanooga, TN, CCN 440091

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6362TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Health Partners Foundation Inc CurrentSince Jun 9, 2025 Accepting new patients
Memorial Health Partners Foundation, Inc CurrentSince Jun 9, 2025 Accepting new patients

Locations

5600 Brainerd Rd
Ste 500
Chattanooga, TN 37411
Phone (423) 414-3586

2525 Desales Ave
Chattanooga, TN 37404
Phone (423) 495-2620

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1736812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748304000000",
    "number": "1629889290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 DESALES AVE",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374041161",
            "telephone_number": "423-495-2525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 DESALES AVE",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374041161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDERS",
        "first_name": "GRAYSON",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-01-14",
        "last_updated": "2025-05-27",
        "certification_date": "2025-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chattanooga, TN

Sources for this page

Verify at the official NPI Registry.