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1912960659
JERALD DEAN GRISSOM
WINSTON SALEM, NC
NPI
1912960659
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: NC 0010-04281)
Enumeration Date
2006-04-11
Last Update Date
2014-02-17
Business Address
-- JERALD DEAN GRISSOM PA-C
MEDICAL CENTER BLVD
WINSTON SALEM, NC 27157-0001
Phone number: 336-716-8898
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Mailing Address
-- JERALD DEAN GRISSOM PA-C
2271 N NC 119
MEBANE, NC 27302
Phone number: 336-380-7277
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