Healthcare Provider Details

I. General information

NPI: 1841233954
Provider Name (Legal Business Name): DANIEL JOSHUA GRUSKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2165 N DECATUR RD ROOM 166
DECATUR GA
30033-5307
US

IV. Provider business mailing address

178 ELVAN AVE NE
ATLANTA GA
30317-1356
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-8570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number053817
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207SG0202X
TaxonomyClinical Biochemical Genetics Physician
License Number053817
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: