Provider Demographics
NPI:1730372236
Name:GRIMSLEY, WILLIAM ROSS (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROSS
Last Name:GRIMSLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:
Practice Address - Street 1:1689 OLD PENDERGRASS RD
Practice Address - Street 2:SUITE 340
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-2708
Practice Address - Country:US
Practice Address - Phone:770-848-5400
Practice Address - Fax:770-848-5424
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2021-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA066498207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003110454AMedicaid