Provider Demographics
NPI:1366470650
Name:GRINER, BRIAN C (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:C
Last Name:GRINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 N OAK STREET EXT
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605
Mailing Address - Country:US
Mailing Address - Phone:229-242-6061
Mailing Address - Fax:229-242-6151
Practice Address - Street 1:3301 N OAK STREET EXT
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-1014
Practice Address - Country:US
Practice Address - Phone:229-242-6061
Practice Address - Fax:229-242-6151
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046966207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000819706CMedicaid
GA000819706DMedicaid
GA875175410AMedicaid
GA901359126BMedicaid
GA000819706EMedicaid
GA003138857AMedicaid
GA901359126AMedicaid
GA000819706CMedicaid
GA003138857AMedicaid