Basic Information
Provider Information
NPI: 1003013160
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GRABENSTEIN
FirstName: WILLIAM
MiddleName: P.
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1822 MEMORIAL DR
Address2:  
City: CLARKSVILLE
State: TN
PostalCode: 370434605
CountryCode: US
TelephoneNumber: 9315528012
FaxNumber: 9315513118
Practice Location
Address1: 1822 MEMORIAL DR
Address2:  
City: CLARKSVILLE
State: TN
PostalCode: 370434605
CountryCode: US
TelephoneNumber: 9315528012
FaxNumber: 9315513118
Other Information
ProviderEnumerationDate: 06/29/2007
LastUpdateDate: 07/29/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XMD017935TNY Allopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
372881705TN MEDICAID
372881701TNMEDICARE PTANOTHER
410230701TNBLUE CROSS BLUE SHIELDOTHER


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