Provider Demographics
NPI:1851830178
Name:PATRONUS PHYSICIANS GROUP PC
Entity Type:Organization
Organization Name:PATRONUS PHYSICIANS GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-822-4823
Mailing Address - Street 1:8000 TOWERS CRESCENT DR
Mailing Address - Street 2:SUITE 1350
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-6207
Mailing Address - Country:US
Mailing Address - Phone:866-450-1918
Mailing Address - Fax:
Practice Address - Street 1:8000 TOWERS CRESCENT DR
Practice Address - Street 2:SUITE 1350
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-6207
Practice Address - Country:US
Practice Address - Phone:866-450-1918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular NeurologyGroup - Multi-Specialty