Provider Demographics
NPI:1770779332
Name:GRELLE, KATHERINE WALDROP (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:WALDROP
Last Name:GRELLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:439 ADMIRAL CT
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-5303
Mailing Address - Country:US
Mailing Address - Phone:205-305-0034
Mailing Address - Fax:205-462-7618
Practice Address - Street 1:1800 MCFARLAND BLVD N STE 150
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2178
Practice Address - Country:US
Practice Address - Phone:205-759-1729
Practice Address - Fax:205-759-1729
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2024-08-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ALL2886R207Q00000X
ALL.3071R207Q00000X
VA0101246908207Q00000X
MS22936207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine