Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 020720 | GA |
NPI | 1235171380 |
---|---|
Provider Name | Dr. Thomas A. Grillo |
First Address | Snellville, GA 30078-6782 |
Second Address | Snellville, GA 30078-6782 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00240831A | (05) | GA |
D29620 | (02) |