Grace Family Practice Clinic, P.c.

NPI #1083124671 in Dyersburg, Tennessee

Provider Information

NPI Number: 1083124671
Entity Type: Organization
Organization Name: Grace Family Practice Clinic, P.c.
Primary Specialty: Family Medicine
Enumeration Date: Oct 9, 2017
Last Updated: Oct 9, 2017

Practice Location

Address: 1716 PARR AVE STE D
City: Dyersburg
State: Tennessee
ZIP Code: 38024-2074
Phone: (731) 288-0911

Authorized Official

Name: MONIQUE CASEY-BOLDEN, M.D.
Title: PRESIDENT
Phone: (731) 288-0911

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary
Nurse Practitioner - Family — Family	363LF0000X

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