Provider Demographics
NPI:1265688006
Name:GRUBB, KENDRA JANEL (MD)
Entity Type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:JANEL
Last Name:GRUBB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:550 PEACHTREE ST NE FL 6
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2212
Mailing Address - Country:US
Mailing Address - Phone:404-686-2513
Mailing Address - Fax:404-686-4959
Practice Address - Street 1:550 PEACHTREE ST NE FL 6
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2212
Practice Address - Country:US
Practice Address - Phone:404-686-2513
Practice Address - Fax:404-686-4959
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2018-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036120433208600000X
KY45160208G00000X
GA79606208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)