MEDICARE: JASON DAVID GRABROVAC PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	004057	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023000528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON DAVID GRABROVAC PA-C

Provider Business Mailing Address
First Line	:	1100 NORTHSIDE FORSYTH DR
Second Line	:	SUITE 340
City	:	CUMMING
State	:	GA
Zip	:	30041-6012
Country	:	US
Telephone Number	:	770-886-8111
Fax Number	:	770-205-8539

Provider Business Practice Location Address
First Line	:	1100 NORTHSIDE FORSYTH DR
Second Line	:	SUITE 340
City	:	CUMMING
State	:	GA
Zip	:	30041-6012
Country	:	US
Telephone Number	:	770-886-8111
Fax Number	:	770-205-8539

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	03/21/2013

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Directions to “ JASON DAVID GRABROVAC PA-C” Practice Location

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