Basic Information
| Provider Information | |||||||||
| NPI: | 1003013160 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRABENSTEIN | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | P. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD017935 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3728817 | 01 | TN | MEDICARE PTAN | OTHER | 4102307 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | 3728817 | 05 | TN | MEDICAID |