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NPI Code Detail

MEDICARE: JOHNSIE CAROL GRIGG M.D.

MEDICARE:   JOHNSIE CAROL GRIGG  M.D.
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
1207Q00000XFamily Medicine PhysicianME47294FL
2207P00000XEmergency Medicine PhysicianME47294FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00149413OTHERFLRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
104633OTHERFLBLUE CROSS BLUE SHIELD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932102159
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHNSIE CAROL GRIGG M.D.
Provider Business Mailing Address
First Line : PO BOX 9671
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32120-9671
Country : US
Telephone Number : 386-676-7130
Fax Number : 386-676-7125
Provider Business Practice Location Address
First Line : 1340 RIDGEWOOD AVE
Second Line :
City : HOLLY HILL
State : FL
Zip : 32117-2320
Country : US
Telephone Number : 386-676-7130
Fax Number : 386-676-7125
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 06/21/2012

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Directions to “ JOHNSIE CAROL GRIGG M.D.” Practice Location

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