Individual
DR. PETER DANIEL GROSSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1115 GARREDD BLVD, AUGUSTA, GA 30909-6674
(706) 922-0101
(706) 364-0056
Mailing address
1115 GARREDD BLVD, AUGUSTA, GA 30909-6674
(706) 922-0101
(706) 364-0056
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
032198
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000437841D
—
GA
01
—
032198
LICENSE
GA
01
—
24779
LICENSE
SC
01
—
30000001SVGEAC
EHR CERTIFICATION #
GA
01
—
52022556
BCBS GA
GA
01
—
G32198
SC MEDICAID
SC
Enumeration date
10/11/2006
Last updated
03/07/2023
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