Healthcare Provider Details

I. General information

NPI: 1407435936
Provider Name (Legal Business Name): ERIK EDWARD GRODUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MEDICAL WAY
SNELLVILLE GA
30078-2195
US

IV. Provider business mailing address

11750 BIRD RD
MIAMI FL
33175-3530
US

V. Phone/Fax

Practice location:
  • Phone: 770-979-0200
  • Fax:
Mailing address:
  • Phone: 305-223-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number162160
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number102962
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: