Organization
GRACE MEDICAL PRACTICE LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FIDELIA O OSINUBI MD (CEO)
(404) 861-0291
Entity
Organization
Contact information
Practice address
1136 CLEVELAND AVE STE 309, EAST POINT, GA 30344-3618
(404) 763-1240
(404) 393-6524
Mailing address
PO BOX 20156, ATLANTA, GA 30325-0156
(404) 861-0291
(404) 393-6524
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
001305
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06/11/1956
BIRTH DATE
GA
05
—
778620923A
—
GA
Enumeration date
10/02/2009
Last updated
10/02/2009
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