Individual
WILLIAM R. GRUBB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-8623
(706) 721-1459
Mailing address
1120 15TH ST STE BI-1056, AUGUSTA, GA 30912-0004
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
85749
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
85749
GA MEDICAL LICENSE
GA
Enumeration date
04/02/2015
Last updated
05/21/2020
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