Provider Demographics
NPI:1639173297
Name:GRYBOSKI, DAVID M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:GRYBOSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:95 COLLIER RD NW
Mailing Address - Street 2:STE 4075
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1751
Mailing Address - Country:US
Mailing Address - Phone:404-603-3543
Mailing Address - Fax:404-350-8795
Practice Address - Street 1:1265 HIGHWAY 54 W
Practice Address - Street 2:STE 409
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4537
Practice Address - Country:US
Practice Address - Phone:678-817-6550
Practice Address - Fax:678-881-6551
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2007-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA035060207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00659128DMedicaid
GA00659128DMedicaid
GA10BBCKDMedicare ID - Type Unspecified