Individual
GRANTLEY JOSEPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4153B FLAT SHOALS PKWY, STE 200, DECATUR, GA 30034-4189
(404) 585-5049
(404) 591-0292
Mailing address
PO BOX 934915, ATLANTA, GA 31193-4915
(404) 501-7969
(404) 501-3874
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
039376
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000671019A
—
GA
01
—
110121708
RAIL ROAD MEDICARE
—
01
—
5492108
AETNA
—
01
—
658015
BLUE CROSS BLUE SHIELDS
—
Enumeration date
08/17/2006
Last updated
11/25/2014
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