Provider Demographics
NPI:1285191049
Name:GRIMES, SHANDRA LADELL (NP)
Entity Type:Individual
Prefix:MRS
First Name:SHANDRA
Middle Name:LADELL
Last Name:GRIMES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7351 OLD MOON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-7291
Mailing Address - Country:US
Mailing Address - Phone:706-653-7000
Mailing Address - Fax:706-653-7800
Practice Address - Street 1:2300 MANCHESTER EXPWY ST FRANCIS HOSPITAL
Practice Address - Street 2:SUITE C-001
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904
Practice Address - Country:US
Practice Address - Phone:706-596-4000
Practice Address - Fax:706-320-8327
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN142131363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology