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General NPI Number Information
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NPI Number | 1093887168
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Entity Type | Organization
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Legal Business Name | GRACE MEDICAL CLINIC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 08/11/2010
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Provider Practice Location Address
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Address Line | 230 W COLLEGE ST B
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City | GRIFFIN
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State | GA
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Zip | 30224-4121
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Country | US
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Telephone | 678-688-1155
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Fax | 678-688-5071
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Provider Business Mailing Address
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Address Line | 230 W COLLEGE ST B
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City | GRIFFIN
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State | GA
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Zip | 30224-4121
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Country | US
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Telephone | 678-688-1155
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Fax | 678-688-5071
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. EHI PHILIP OSEHOBO
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Credential | M.D.
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Telephone | 678-688-1155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 049075
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License Number State | GA
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