Provider Demographics
NPI:1407233372
Name:GRENADE, TORI BROOKE (MD)
Entity Type:Individual
Prefix:
First Name:TORI
Middle Name:BROOKE
Last Name:GRENADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 WATSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3431
Mailing Address - Country:US
Mailing Address - Phone:478-922-4281
Mailing Address - Fax:
Practice Address - Street 1:701 GROVE RD
Practice Address - Street 2:ATT: RESIDENCY COORDINDATOR
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5611
Practice Address - Country:US
Practice Address - Phone:864-455-7844
Practice Address - Fax:864-455-7848
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA83844208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics