GRACE MEDICAL PRACTICE LTD NPI 1396070744

NPI Information

  • NPI: 1396070744
  • Provider Name: GRACE MEDICAL PRACTICE LTD
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • CLIA Number: 11D2003401
  • Address: 1136 CLEVELAND AVE STE 309
    EAST POINT, GA
    ZIP 30344
  • Phone: (404) 763-1240

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NPI Details

GRACE MEDICAL PRACTICE LTD is a family medicine in East Point, GA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. GRACE MEDICAL PRACTICE LTD NPI is 1396070744. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1136 CLEVELAND AVE STE 309
EAST POINT, GA
ZIP 30344-618
Phone: (404) 763-1240
Fax: (404) 393-6524

The provider's authorized official is Fidelia O Osinubi .
The authorized official title is Ceo and has the following contact phone number (404) 861-0291.

The CLIA number assigned to this NPI record is 11D2003401 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/2/2009 and was last updated on 10/2/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine001305GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
106/11/1956OTHERGEORGIABIRTH DATE
2778620923AMEDICAIDGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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