Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 76724 | GA |
N | 2080P0208X | Pediatric Infectious Diseases | 76724 | GA |
NPI | 1558628818 |
---|---|
Provider Name | Dr. Cassie Marie Grimsley Ackerley |
First Address | Decatur, GA 30033-2663 |
Second Address | Decatur, GA 30033-2663 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2012 |
Last Update Date | 12/06/2020 |