Provider Demographics
NPI:1760810857
Name:GROSSMAN, MICHAEL (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 JOHNSON FERRY RD
Mailing Address - Street 2:STE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1631
Mailing Address - Country:US
Mailing Address - Phone:404-257-0006
Mailing Address - Fax:404-851-1316
Practice Address - Street 1:960 JOHNSON FERRY RD
Practice Address - Street 2:STE 500
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1631
Practice Address - Country:US
Practice Address - Phone:404-257-0006
Practice Address - Fax:404-851-1316
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN206831363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care