Individual
MRS. EMILY ANNE GRIMM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA- C
Contact information
Practice address
2055 E SOUTH BLVD STE 603, MONTGOMERY, AL 36116-2014
(334) 747-8800
(334) 747-8810
Mailing address
301 BROWN SPRINGS RD, MONTGOMERY, AL 36117-7005
(334) 273-4159
(334) 273-4556
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA.706
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102I975474
MEDICARE
AL
05
—
200067000A
—
OK
05
—
207629
—
AL
Enumeration date
07/24/2006
Last updated
01/24/2018
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