Healthcare Provider Details

I. General information

NPI: 1134815848
Provider Name (Legal Business Name): JAMES TRENTON GRINER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 SHORTER AVE NW STE 201
ROME GA
30165-4256
US

IV. Provider business mailing address

304 SHORTER AVE NW STE 201
ROME GA
30165-4256
US

V. Phone/Fax

Practice location:
  • Phone: 706-509-3300
  • Fax:
Mailing address:
  • Phone: 706-509-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number113893
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: