Graceland Internal Medicine

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD010326 Issued in TN

Legal business name

GRACELAND INTERNAL MEDICINE

Practice address

1264 Wesley Dr
Suite 405
Memphis, TN 38116-6400

Phone

(901) 396-3061

Fax

(901) 396-7841

NPI assigned

Jul 15, 2006

Organization subpart

No

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

Authorized official

Name

Theresa F Edmiston

Title

Administrator

Phone

(901) 340-6777

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1851317333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1264 WESLEY DR",
            "address_2": "SUITE 405",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381166400",
            "telephone_number": "901-396-3061",
            "fax_number": "901-396-7841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1264 WESLEY DR",
            "address_2": "SUITE 405",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381166400",
            "telephone_number": "901-396-3061",
            "fax_number": "901-396-7841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACELAND INTERNAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EDMISTON",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "901-340-6777"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "MD010326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3372151",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Grace Therapy Group, LLC
• Grace-N-Mercy Home Service
• Trayl Grace, DO
• Graceage Cares LLC
• Graceful Comfort Home Care Service, LLC
• Graceland Nursing Center, LLC
• Graceland Nursing Operator LLC
• Carolyn M Gracia, APRN
• Joel Francis Gradowski, M.D.
• Gradually Restoring Our Walk Inc (GROW, Inc)

• Internal Medicine Physician in Memphis, TN
• Providers in Memphis, TN by specialty
• Internal Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.