| Doctor Name: | DR. LEANDER M GRIMM |
| NPI Number: | 1598877805 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 12705MS |
| Business Practice Address: | 401 Southcrest Circle Suite 204 Southaven, MS - 38671 |
| Business Phone Number: | 6623490311 |
| Business Fax Number: | 6623490121 |
| Mailing Address: | Po Box 405827, ATLANTA |
| State: | GA |
| Postal Code: | 303845827 |
| Phone Number: | 8709345812 |
| Fax Number: | 8709345384 |
| NPI Enumeration Date: | 08/31/2006 |
| NPI Last Update Date: | 07/26/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 12705MS |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MS |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |