Individual
DOMINIQUE MICHELLE GRASTY HINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4581 S COBB DR SE STE 100, SMYRNA, GA 30080-6906
(770) 801-5000
(770) 435-6690
Mailing address
4581 S COBB DR SE STE 100, SMYRNA, GA 30080-6906
(770) 801-5000
(770) 435-6690
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
95066
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2020
Last updated
09/06/2023
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