Provider Demographics
NPI:1235356759
Name:MCDONALD-GRIMM, KRISTY G (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:G
Last Name:MCDONALD-GRIMM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTINE
Other - Middle Name:G
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:770-942-0457
Mailing Address - Fax:770-942-7699
Practice Address - Street 1:4586 TIMBER RIDGE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135
Practice Address - Country:US
Practice Address - Phone:770-942-0457
Practice Address - Fax:770-942-7699
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA069069207RH0003X, 207RH0003X
GARTP 001890207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003131763BMedicaid
GA003131763AMedicaid
GA003131763AMedicaid