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NPI Code Detail

MEDICARE: ADDISON GRICE

MEDICARE: ADDISON GRICE
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
1363A00000XPhysician Assistant13423GA

General Provider Information

NPI Number : 1447040183
Entity Type Code : Individual
Provider Name (Legal Business Name) : ADDISON GRICE
Provider Business Mailing Address
First Line : PO BOX 3726
Second Line :
City : AUGUSTA
State : GA
Zip : 30914-3726
Country : US
Telephone Number : 706-863-9595
Fax Number : 706-868-8375
Provider Business Practice Location Address
First Line : 3651 WHEELER RD
Second Line :
City : AUGUSTA
State : GA
Zip : 30909-6521
Country : US
Telephone Number : 706-863-9595
Fax Number : 706-868-8375
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2025
Last Update Date : 03/20/2026

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Directions to “ ADDISON GRICE ” Practice Location

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