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NPI Code Detail

MEDICARE: DR. GRANT ADAM DOORNBOS M.D.

MEDICARE: DR. GRANT ADAM DOORNBOS 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
1207L00000XAnesthesiology Physician069398GA

General Provider Information

NPI Number : 1376785600
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GRANT ADAM DOORNBOS M.D.
Provider Business Mailing Address
First Line : 3804 GLENGARRY WAY NE
Second Line :
City : ROSWELL
State : GA
Zip : 30075-2615
Country : US
Telephone Number : 404-245-3687
Fax Number :
Provider Business Practice Location Address
First Line : 1300 RIDENOUR BLVD NW STE 300
Second Line :
City : KENNESAW
State : GA
Zip : 30152-4402
Country : US
Telephone Number : 770-702-1806
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2009
Last Update Date : 03/28/2018

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