Provider Demographics
NPI:1922683507
Name:GRACE MEDICAL INSTITUTE
Entity type:Organization
Organization Name:GRACE MEDICAL INSTITUTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:470-489-7917
Mailing Address - Street 1:79 DOGWOOD FERRY CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-9328
Mailing Address - Country:US
Mailing Address - Phone:470-881-2285
Mailing Address - Fax:470-945-4151
Practice Address - Street 1:655 VILLAGE SQUARE DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3300
Practice Address - Country:US
Practice Address - Phone:470-881-2285
Practice Address - Fax:470-945-4151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GASCHOOLOtherEDUCATION SERVICES