Healthcare Provider Details

I. General information

NPI: 1528628385
Provider Name (Legal Business Name): MONICA ENPERATRIS GRIMALDO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 W LYON ST
TALLAPOOSA GA
30176-1288
US

IV. Provider business mailing address

25 W LYON ST
TALLAPOOSA GA
30176-1288
US

V. Phone/Fax

Practice location:
  • Phone: 770-812-2800
  • Fax: 770-824-2825
Mailing address:
  • Phone: 770-812-2800
  • Fax: 770-824-2810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN-NP226645
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: