Healthcare Provider Details

I. General information

NPI: 1710316161
Provider Name (Legal Business Name): DR. ANITA K. GROVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 CLIFTON RD NE
ATLANTA GA
30322-3691
US

IV. Provider business mailing address

140 DECATUR ST.
ATLANTA GA
30303
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-3543
  • Fax:
Mailing address:
  • Phone: 404-413-6245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number003734
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number003734
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: