MEDICARE: MR. SHERWOOD O GRIGGS SR. CSA

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	246ZS0410X	Surgical Technologist	2894	GA

General Provider Information

NPI Number	:	1669514089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHERWOOD O GRIGGS SR. CSA

Provider Business Mailing Address
First Line	:	2963 LEXINGTON TRACE DR SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-3784
Country	:	US
Telephone Number	:	706-351-1612
Fax Number	:

Provider Business Practice Location Address
First Line	:	2963 LEXINGTON TRACE DR SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-3784
Country	:	US
Telephone Number	:	706-351-1612
Fax Number	:

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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