Provider Demographics
NPI:1891016861
Name:GROSSE, ANDREW V (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:V
Last Name:GROSSE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 PAULSEN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-3662
Mailing Address - Country:US
Mailing Address - Phone:912-355-6615
Mailing Address - Fax:912-354-5970
Practice Address - Street 1:4425 PAULSEN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-3662
Practice Address - Country:US
Practice Address - Phone:912-355-6615
Practice Address - Fax:912-354-5970
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005838363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant