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General NPI Number Information
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NPI Number | 1558628818
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Entity Type | Individual
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Provider Name | CASSIE GRIMSLEY ACKERLEY MD, MSC
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Gender | Female
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Dates
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Enumeration Date | 04/11/2012
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 500 IRVIN CT STE 200
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City | DECATUR
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State | GA
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Zip | 30030-1705
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Country | US
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Telephone | 404-712-1370
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Fax |
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Provider Business Mailing Address
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Address Line | 3131 N DRUID HILLS RD APT 10103
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City | DECATUR
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State | GA
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Zip | 30033-2663
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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 | 2080P0208X
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Taxonomy Name | Pediatric Infectious Diseases Physician
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License Number | 76724
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 76724
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License Number State | GA
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