Provider Demographics
NPI:1265606644
Name:GRUNCH, BETSY H (MD)
Entity type:Individual
Prefix:DR
First Name:BETSY
Middle Name:H
Last Name:GRUNCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:DEANINA
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-533-4786
Practice Address - Street 1:1240 JESSE JEWELL PKWY SE
Practice Address - Street 2:STE 300
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-534-7200
Practice Address - Fax:678-450-3778
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC141424207T00000X
GA069414207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52608061OtherBCBS
GA902740OtherWELLCARE
GAP01257674OtherPALMETTO GBA - RAILROAD MEDCARE
GA003133726AMedicaid
GA01887105OtherAMERIGROUP
GA003133726BMedicaid
GA003133726CMedicaid
GA003133726DMedicaid
GA003133726EMedicaid
GA3618296OtherUHC