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General NPI Number Information
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NPI Number | 1083059760
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Entity Type | Organization
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Legal Business Name | C N GRIMES, INC
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Dates
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Enumeration Date | 05/08/2013
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Last Update Date | 05/08/2013
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Provider Practice Location Address
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Address Line | 920 DANNON VW SW SUITE 3104
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City | ATLANTA
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State | GA
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Zip | 30331-2157
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Country | US
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Telephone | 404-629-3933
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Fax |
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Provider Business Mailing Address
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Address Line | 2654 ARROWOOD DR
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City | EAST POINT
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State | GA
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Zip | 30344-3810
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MR. CORNELIUS CLAYBORNE GRIMES
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Credential | LCSW
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Telephone | 404-840-0640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW004068
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License Number State | GA
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