Provider Demographics
NPI:1902863004
Name:GRUBBS, EARL ALWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:ALWIN
Last Name:GRUBBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 HIGH BRIDGE CHASE
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-5512
Mailing Address - Country:US
Mailing Address - Phone:770-740-9231
Mailing Address - Fax:770-569-4598
Practice Address - Street 1:375 HIGH BRIDGE CHASE
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-5512
Practice Address - Country:US
Practice Address - Phone:770-740-9231
Practice Address - Fax:770-569-4598
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032742207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000471589BMedicaid
A50168Medicare UPIN
GA93BDHCSMedicare ID - Type Unspecified