Healthcare Provider Details

I. General information

NPI: 1215860457
Provider Name (Legal Business Name): ANDREA GRIMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2465 OAKLAND SPRING DR
SNELLVILLE GA
30039-7960
US

IV. Provider business mailing address

2465 OAKLAND SPRING DR
SNELLVILLE GA
30039-7960
US

V. Phone/Fax

Practice location:
  • Phone: 404-890-0388
  • Fax:
Mailing address:
  • Phone: 404-890-0388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberNT015209
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: