1114252426 NPI number — DEANNA R. GRIM, ED.D., INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114252426 NPI number — DEANNA R. GRIM, ED.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEANNA R. GRIM, ED.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114252426
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 MAXWELL RD
Provider Second Line Business Mailing Address:
SUITE 600 C
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30009-2070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-300-4746
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 MAXWELL RD
Provider Second Line Business Practice Location Address:
SUITE 600 C
Provider Business Practice Location Address City Name:
ALPHARETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30009-2070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-300-4746
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GRIM
Authorized Official First Name:
DEANNA
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
678-300-4746

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC 615 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 099972183A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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