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General NPI Number Information
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NPI Number | 1598276057
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Entity Type | Individual
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Provider Name | TAYLORE MARIE GRIMM PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/23/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 979 E 3RD ST STE C-520
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City | CHATTANOOGA
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State | TN
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Zip | 37403-2136
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Country | US
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Telephone | 423-778-5661
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Fax | 423-778-5664
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Provider Business Mailing Address
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Address Line | 6522 ORANGE PLANK DR
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City | HIXSON
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State | TN
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Zip | 37343-3394
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Country | US
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Telephone | 219-575-1011
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 3397
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 3397
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License Number State | TN
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