Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 46109 | GA |
NPI | 1104823145 |
---|---|
Provider Name | Dr. Jeffrey S Grossman |
First Address | Atlanta, GA 30342-1703 |
Second Address | Atlanta, GA 30342-1703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2005 |
Last Update Date | 20/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
702813 | BLUE CROSS BLUE SHIELD GA (01) | GA |
7085282 | AETNA (01) | |
H43542 | (02) | |
P00055192 | MEDICARE RR (01) |