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General NPI Number Information
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NPI Number | 1306802772
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Entity Type | Individual
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Provider Name | TIMOTHY GRINER M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 10/11/2012
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Provider Practice Location Address
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Address Line | 4165 OLD MILTON PKWY SUITE 108
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City | ALPHARETTA
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State | GA
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Zip | 30005-4468
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Country | US
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Telephone | 770-594-3427
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Fax |
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Provider Business Mailing Address
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Address Line | 870 SADDLE HILL RD
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City | ROSWELL
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State | GA
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Zip | 30075-1249
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 043055
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License Number State | GA
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