Healthcare Provider Details

I. General information

NPI: 1346411899
Provider Name (Legal Business Name): SARA R GRIMSLEY PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA GRIMSLEY AUGUSTIN PHARM.D.

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 WINN WAY
DECATUR GA
30030-1715
US

IV. Provider business mailing address

450 WINN WAY
DECATUR GA
30030-1715
US

V. Phone/Fax

Practice location:
  • Phone: 404-508-7774
  • Fax:
Mailing address:
  • Phone: 404-508-7774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number016101
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: