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General NPI Number Information
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NPI Number | 1336441294
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Entity Type | Organization
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Legal Business Name | C GRACE CORPORATION
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Dates
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Enumeration Date | 11/29/2010
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Last Update Date | 11/29/2010
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Provider Practice Location Address
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Address Line | 3885 MUNDY MILL RD
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City | OAKWOOD
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State | GA
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Zip | 30566-3432
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Country | US
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Telephone | 770-297-1070
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Fax |
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Provider Business Mailing Address
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Address Line | 420 LONGWOOD LN
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City | ALPHARETTA
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State | GA
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Zip | 30004-3994
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Country | US
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Telephone | 404-273-2090
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Fax | 678-395-5954
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Authorized Official
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Title or Position | OWNER/CEO
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Name | RICHARD R GRAHAM
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Credential |
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Telephone | 404-273-2090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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