Provider Demographics
NPI:1922683507
Name:GRACE MEDICAL INSTITUTE
Entity Type:Organization
Organization Name:GRACE MEDICAL INSTITUTE
Other - Org Name:GRACE MEDICAL INSTITUTE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-829-4988
Mailing Address - Street 1:2385 WALL ST SE STE 204A
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2187
Mailing Address - Country:US
Mailing Address - Phone:678-590-1170
Mailing Address - Fax:678-623-8500
Practice Address - Street 1:2385 WALL ST SE STE 204A
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2187
Practice Address - Country:US
Practice Address - Phone:678-590-1170
Practice Address - Fax:678-623-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GASCHOOLOtherEDUCATION SERVICES