Provider Demographics
NPI:1972720415
Name:GREY-MCBRIDE, MONIQUE A (MD)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:A
Last Name:GREY-MCBRIDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:A
Other - Last Name:GREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3650 STEVE REYNOLDS BLVD
Mailing Address - Street 2:DEPARTMENT OF ORTHOPEDICS, KAISER GWINNETT MEDICAL CTR
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4506
Mailing Address - Country:US
Mailing Address - Phone:404-365-0966
Mailing Address - Fax:
Practice Address - Street 1:3650 STEVE REYNOLDS BLVD
Practice Address - Street 2:DEPARTMENT OF ORTHOPEDICS, KAISER GWINNETT MEDICAL CTR
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4506
Practice Address - Country:US
Practice Address - Phone:404-365-0966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98332207X00000X
GA071236207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00436646OtherMEDICARE RAILROAD
FL310423OtherAVMED
FL1653834OtherAETNA
FL96131OtherBC/BS
FL278450500Medicaid
FL4614663OtherCIGNA
FLAE488ZMedicare PIN