Individual
DR. BENNETT DOUGLAS GRIMM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
61 WHITCHER ST NE, SUITE 1100, MARIETTA, GA 30060-1176
(770) 422-3290
(770) 422-0287
Mailing address
61 WHITCHER ST NE, SUITE 1100, MARIETTA, GA 30060-1176
(770) 422-3290
(770) 422-0287
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
068525
GA
207X00000X
Orthopaedic Surgery Physician
2012-00860
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003136592A
—
GA
05
—
003136592B
—
GA
05
—
003136592C
—
GA
Enumeration date
10/19/2006
Last updated
08/23/2013
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