MEDICARE: GEORGE P. GRIMES, PHD, PA

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	103TC0700X	Clinical Psychologist	32666	TX

General Provider Information

NPI Number	:	1477990018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE P. GRIMES, PHD, PA

Provider Business Mailing Address
First Line	:	480 MARINERS DR
Second Line	:
City	:	KEMAH
State	:	TX
Zip	:	77565-2261
Country	:	US
Telephone Number	:	979-417-4294
Fax Number	:	281-538-8069

Provider Business Practice Location Address
First Line	:	480 MARINERS DR
Second Line	:
City	:	KEMAH
State	:	TX
Zip	:	77565-2261
Country	:	US
Telephone Number	:	979-417-4294
Fax Number	:	281-538-8069

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GEORGE PERRY GRIMES
Credential	:	PHD
Telephone Number	:	979-417-4294

Provider Enumeration Date	:	05/22/2013
Last Update Date	:	05/22/2013

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