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NPI Code Detail

MEDICARE: WENDY K GRAGE CSFA

MEDICARE: WENDY K GRAGE CSFA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1246ZC0007XSurgical Assistant

General Provider Information

NPI Number : 1033308739
Entity Type Code : Individual
Provider Name (Legal Business Name) : WENDY K GRAGE CSFA
Provider Business Mailing Address
First Line : 1765 OLD WEST BROAD ST BLDG 2-200
Second Line :
City : ATHENS
State : GA
Zip : 30606-2887
Country : US
Telephone Number : 706-549-1663
Fax Number : 706-546-8792
Provider Business Practice Location Address
First Line : 3440 HIGHWAY 81
Second Line :
City : LOGANVILLE
State : GA
Zip : 30052-9112
Country : US
Telephone Number : 706-549-1663
Fax Number : 706-546-8792
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2007
Last Update Date : 08/20/2025

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