Provider Demographics
NPI:1407440456
Name:GRINDLEY, JANNA MARIE
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:MARIE
Last Name:GRINDLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SUNSHINE LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NC
Mailing Address - Zip Code:28722-0237
Mailing Address - Country:US
Mailing Address - Phone:828-859-7659
Mailing Address - Fax:
Practice Address - Street 1:11 SUNSHINE LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722-0237
Practice Address - Country:US
Practice Address - Phone:828-859-7659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001010840363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant