Provider Demographics
NPI:1407159650
Name:MICHAEL J GRUNDY MD PC
Entity Type:Organization
Organization Name:MICHAEL J GRUNDY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-355-7050
Mailing Address - Street 1:35 COLLIER RD NW STE 520
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1606
Mailing Address - Country:US
Mailing Address - Phone:404-355-7050
Mailing Address - Fax:404-351-1670
Practice Address - Street 1:35 COLLIER RD NW STE 520
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1606
Practice Address - Country:US
Practice Address - Phone:404-355-7050
Practice Address - Fax:404-351-1670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA26537261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
D29634Medicare UPIN
448447216AMedicare PIN