Healthcare Provider Details

I. General information

NPI: 1144678848
Provider Name (Legal Business Name): DEMETRICE GRIER APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 MIKE PADGETT HWY
AUGUSTA GA
30906-3815
US

IV. Provider business mailing address

328 SUMMERFIELD CIR
GROVETOWN GA
30813-2206
US

V. Phone/Fax

Practice location:
  • Phone: 706-432-4800
  • Fax:
Mailing address:
  • Phone: 484-213-3865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN253267
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN253267
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: