Individual
DR. LEANDER M GRIMM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
401 SOUTHCREST CIRCLE, SUITE 204, SOUTHAVEN, MS 38671
(662) 349-0311
(662) 349-0121
Mailing address
PO BOX 405827, ATLANTA, GA 30384-5827
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
12705
MS
208600000X
Surgery Physician
20507
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00111800
—
MS
05
—
3726800
—
TN
01
—
4091934
BCBS TN PROVIDER NUMBER
TN
Enumeration date
08/31/2006
Last updated
10/20/2016
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