Doctor Name: | DACENTA GRICE |
NPI Number: | 1003205287 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA |
License Number: | 003279 |
Business Practice Address: | 5582 Memorial Dr Stone Mountain, GA - 300833215 |
Business Phone Number: | 4042988998 |
Business Fax Number: | 4042987658 |
Mailing Address: | 5582 Memorial Dr, STONE MOUNTAIN |
State: | GA |
Postal Code: | 300833215 |
Phone Number: | 4042988998 |
Fax Number: | 4042987658 |
NPI Enumeration Date: | 01/12/2015 |
NPI Last Update Date: | 02/09/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 003279 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |