Provider Demographics
NPI:1366214629
Name:DAILEY, GRADY JR
Entity type:Individual
Prefix:MR
First Name:GRADY
Middle Name:
Last Name:DAILEY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 WEXFORD DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-6761
Mailing Address - Country:US
Mailing Address - Phone:571-393-5077
Mailing Address - Fax:
Practice Address - Street 1:235 WEXFORD DR
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-6761
Practice Address - Country:US
Practice Address - Phone:571-393-5077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)