Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 43630 | GA |
N | 2081S0010X | Sports Medicine | 43630 | GA |
N | 213ES0000X | Sports Medicine | 43630 | GA |
NPI | 1295710093 |
---|---|
Provider Name | Dr. Anthony Grasso |
First Address | Marietta, GA 30060-7902 |
Second Address | Marietta, GA 30060-6969 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2005 |
Last Update Date | 06/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43630GA | STATE LICENSE (01) | GA |
G54491 | (02) | GA |