Provider Demographics
NPI:1942318282
Name:GRIMES MUMFREY, JULIE ANNE (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:GRIMES MUMFREY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:GRIMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2705
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-2705
Mailing Address - Country:US
Mailing Address - Phone:256-265-4462
Mailing Address - Fax:256-265-4463
Practice Address - Street 1:401 LOWELL DR SE STE 1
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3738
Practice Address - Country:US
Practice Address - Phone:256-265-4462
Practice Address - Fax:256-265-4463
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL43996207V00000X
TXM4121207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183461603Medicaid
TX183461604Medicaid
TX8S9291OtherBCBS
TX183461601Medicaid
TX183461603Medicaid
TX183461603Medicaid
TX8J0716Medicare PIN
TX183461604Medicaid
TX8L18501Medicare PIN