MEDICARE: ANN GRAGG EARLY MD

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	30051	GA

Other Identifiers

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

General Provider Information

NPI Number	:	1871526715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN GRAGG EARLY MD

Provider Business Mailing Address
First Line	:	550 PEACHTREE ST NE
Second Line	:	SUITE 1620
City	:	ATLANTA
State	:	GA
Zip	:	30308-2247
Country	:	US
Telephone Number	:	404-885-7701
Fax Number	:	404-885-7777

Provider Business Practice Location Address
First Line	:	1955 CLIFF VALLEY WAY NE
Second Line	:	SUITE 120
City	:	ATLANTA
State	:	GA
Zip	:	30329-2476
Country	:	US
Telephone Number	:	404-633-0664
Fax Number	:	404-633-0857

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	10/12/2007

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