Healthcare Provider Details

I. General information

NPI: 1104617869
Provider Name (Legal Business Name): EMILY GRACE DRISCOLL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 REDMOND RD NW
ROME GA
30165-1415
US

IV. Provider business mailing address

123 BRIGHTON CT NE
CALHOUN GA
30701-5202
US

V. Phone/Fax

Practice location:
  • Phone: 706-291-0291
  • Fax:
Mailing address:
  • Phone: 706-263-3442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number13408
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13408
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: