Healthcare Provider Details

I. General information

NPI: 1558628818
Provider Name (Legal Business Name): CASSIE GRIMSLEY ACKERLEY MD, MSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 IRVIN CT STE 200
DECATUR GA
30030-1705
US

IV. Provider business mailing address

3131 N DRUID HILLS RD APT 10103
DECATUR GA
30033-2663
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-1370
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number76724
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number76724
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: