Provider Demographics
NPI:1992699631
Name:GROVE, ANNA (PA-C)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:GROVE
Suffix:
Gender:F
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 1:918 DULUTH HWY STE B
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5319
Mailing Address - Country:US
Mailing Address - Phone:470-610-6165
Mailing Address - Fax:
Practice Address - Street 1:918 DULUTH HWY STE B
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5319
Practice Address - Country:US
Practice Address - Phone:470-610-6165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13108363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant