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NPI Code Detail

MEDICARE: ALICIA GRADY M.D.

MEDICARE: ALICIA GRADY M.D.
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
1207R00000XInternal Medicine Physician055368GA
2207R00000XInternal Medicine Physician55368GA

Other Identifiers

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

General Provider Information

NPI Number : 1235113002
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALICIA GRADY M.D.
Provider Business Mailing Address
First Line : 1631 HIGHWAY 20 W
Second Line :
City : MCDONOUGH
State : GA
Zip : 30253-7311
Country : US
Telephone Number : 770-288-2822
Fax Number :
Provider Business Practice Location Address
First Line : 1631 HIGHWAY 20 W
Second Line :
City : MCDONOUGH
State : GA
Zip : 30253-7311
Country : US
Telephone Number : 770-288-2822
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2005
Last Update Date : 01/12/2026

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Directions to “ ALICIA GRADY M.D.” Practice Location

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