Provider Demographics
NPI:1568631224
Name:GRINDLE, CHRISTY LEA (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:LEA
Last Name:GRINDLE
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:LEA
Other - Last Name:WALLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-533-4786
Practice Address - Street 1:725 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3834
Practice Address - Country:US
Practice Address - Phone:770-535-3611
Practice Address - Fax:770-535-7092
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN136984363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA441164OtherWELLCARE
GA787541872EMedicaid
GA441165OtherWELLCARE
GA787541872FMedicaid
GA441157OtherWELLCARE
GA441150OtherWELLCARE
GA787541872AMedicaid
GA787541872CMedicaid
GA787541872AMedicaid