Healthcare Provider Details

I. General information

NPI: 1487070397
Provider Name (Legal Business Name): PATRICK DAVID GRIMM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2014
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 W WHEELER PKWY
AUGUSTA GA
30909-6625
US

IV. Provider business mailing address

300 EAST HOSPITAL ROAD
FORT EISENHOWER GA
30905
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-3585
  • Fax:
Mailing address:
  • Phone: 706-787-3275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2020-01095
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number90738
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number90738
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: