Provider Demographics
NPI:1093721532
Name:GRUBB, WILLIAM GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GEORGE
Last Name:GRUBB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3025 SHRINE RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4744
Mailing Address - Country:US
Mailing Address - Phone:912-264-6133
Mailing Address - Fax:912-267-1415
Practice Address - Street 1:3025 SHRINE RD
Practice Address - Street 2:SUITE 450
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4744
Practice Address - Country:US
Practice Address - Phone:912-264-6133
Practice Address - Fax:912-267-1415
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA016606207R00000X, 207RC0200X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000132965AMedicaid
GA000132965AMedicaid
GA$$$$$$$$$AMedicare PIN