MEDICARE: DR. CINDY LEE GRINES M.D.

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
1	207RC0000X	Cardiovascular Disease Physician	4301048406	MI
2	207RC0000X	Cardiovascular Disease Physician	83705	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0632718	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1679532311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CINDY LEE GRINES M.D.

Provider Business Mailing Address
First Line	:	1110 W PEACHTREE ST NW STE 920
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-3609
Country	:	US
Telephone Number	:	404-962-6000
Fax Number	:	404-962-6001

Provider Business Practice Location Address
First Line	:	1110 W PEACHTREE ST NW STE 920
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-3609
Country	:	US
Telephone Number	:	404-962-6000
Fax Number	:	404-962-6001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	07/14/2023

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