Healthcare Provider Details

I. General information

NPI: 1245140367
Provider Name (Legal Business Name): MICHAEL GRITZBACH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 SAINT JULIAN PL
COLUMBIA SC
29204-2407
US

IV. Provider business mailing address

209 7TH ST FL 3
AUGUSTA GA
30901-1486
US

V. Phone/Fax

Practice location:
  • Phone: 706-842-5330
  • Fax: 706-842-5340
Mailing address:
  • Phone: 706-842-5330
  • Fax: 706-842-5340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2836774
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: