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NPI Code Detail

MEDICARE: JOHN A GRIMES III MD

MEDICARE: JOHN A GRIMES III 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
1207L00000XAnesthesiology Physician200000809NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891783320
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN A GRIMES III MD
Provider Business Mailing Address
First Line : PO BOX 36351
Second Line :
City : CHARLOTTE
State : NC
Zip : 28236-6351
Country : US
Telephone Number : 704-377-5772
Fax Number : 704-377-3389
Provider Business Practice Location Address
First Line : 8800 N TRYON ST
Second Line :
City : CHARLOTTE
State : NC
Zip : 28262-3300
Country : US
Telephone Number : 704-548-5663
Fax Number : 704-548-6997
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2005
Last Update Date : 07/08/2007

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Directions to “ JOHN A GRIMES III MD” Practice Location

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