Healthcare Provider Details

I. General information

NPI: 1790228336
Provider Name (Legal Business Name): HENRY GRIGSBY I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42109 SALEM CT
BELLEVILLE MI
48111-2371
US

IV. Provider business mailing address

42109 SALEM CT
BELLEVILLE MI
48111-2371
US

V. Phone/Fax

Practice location:
  • Phone: 313-461-4789
  • Fax:
Mailing address:
  • Phone: 313-461-4789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: