Provider Demographics
NPI:1649505108
Name:GRUBBS, GEORGE RONNIE JR (PSYD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:RONNIE
Last Name:GRUBBS
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 SUMMER SAILS DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-8004
Mailing Address - Country:US
Mailing Address - Phone:813-662-2307
Mailing Address - Fax:
Practice Address - Street 1:536 SUMMER SAILS DR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-8004
Practice Address - Country:US
Practice Address - Phone:813-789-0552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7985103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical