MICHAEL JEROME GRADY D.O. NPI 1083689533

NPI Information

NPI: 1083689533
Provider Name: MICHAEL JEROME GRADY, D.O.
Classification: Specialist - 174400000X
Entity Type: Individual
Address:
1311 MILSTEAD AVE NE
CONYERS, GA
ZIP 30012
Phone: (770) 483-2368
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Michael Jerome Grady, D.O. is a specialist in Conyers, GA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. Michael Jerome Grady, D.O. NPI is 1083689533. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1311 MILSTEAD AVE NE
CONYERS, GA
ZIP 30012-829
Phone: (770) 483-2368
Fax: (770) 785-5080

The enumeration date for this NPI number is 2/20/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	174400000X	Specialist		029875	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	16BDDJS	MEDICARE ID-TYPE UNSPECIFIED	GEORGIA
2	D45457	MEDICARE UPIN	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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