Individual
GRACE BOGERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
210 VILLAGE CENTER PKWY, STOCKBRIDGE, GA 30281-9044
(770) 474-5952
(770) 474-1300
Mailing address
210 VILLAGE CENTER PKWY, STOCKBRIDGE, GA 30281-9044
(770) 474-5952
(770) 474-1300
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003631
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6537
KAISER
GA
Enumeration date
06/21/2005
Last updated
04/17/2008
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