Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 25835 | OK |
N | 111NI0900X | Internist | 25835 | OK |
Y | 207U00000X | Nuclear Medicine Specialist | 079348 | GA |
N | 207U00000X | Nuclear Medicine Specialist | 125054015 | IL |
N | 207U00000X | Nuclear Medicine Specialist | MD451352 | PA |
NPI | 1396945937 |
---|---|
Provider Name | Erin E Grady |
First Address | Atlanta, GA 30322-1013 |
Second Address | Atlanta, GA 30322-2200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2007 |
Last Update Date | 22/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
079348 | GA LICENSE (01) | GA |
125054015 | ILLINOIS STATE MEDICAL LICENSE (01) | IL |
25835 | OKLAHOMA STATE BOARD OF M (01) | OK |
C1-0009723 | STATE OF DELAWARE (01) | DE |