MEDICARE: GRACE MEDICAL INSTITUTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	174H00000X	Health Educator
2	171W00000X	Contractor
3	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SCHOOL	OTHER	GA	EDUCATION SERVICES

General Provider Information

NPI Number	:	1922683507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE MEDICAL INSTITUTE

Provider Business Mailing Address
First Line	:	79 DOGWOOD FERRY CT
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-9328
Country	:	US
Telephone Number	:	770-904-9173
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 VILLAGE SQUARE DR
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-3300
Country	:	US
Telephone Number	:	470-881-2285
Fax Number	:	470-945-4151

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TAMEKA DUNCAN
Credential	:	CPC
Telephone Number	:	470-489-7917

Provider Enumeration Date	:	03/15/2021
Last Update Date	:	01/31/2026

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Directions to “GRACE MEDICAL INSTITUTE ” Practice Location

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