MEDICARE: SCHELEDA VENIQUE GRIMES MSN, FNP-BC, FNP-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	363LF0000X	Family Nurse Practitioner	61207130	WA
2	363LF0000X	Family Nurse Practitioner	240922	GA

General Provider Information

NPI Number	:	1568129948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCHELEDA VENIQUE GRIMES MSN, FNP-BC, FNP-C

Provider Business Mailing Address
First Line	:	3826 LEISURE WOODS DR
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30034-2118
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5001 PEACHTREE BLVD STE 605
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-2819
Country	:	US
Telephone Number	:	770-415-3554
Fax Number	:

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

Provider Enumeration Date	:	11/20/2021
Last Update Date	:	05/10/2024

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