Provider Demographics
NPI:1104124403
Name:GRINER, DELL RENEE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:DELL
Middle Name:RENEE
Last Name:GRINER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:DELL
Other - Middle Name:RENEE
Other - Last Name:BRITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8668
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-8668
Mailing Address - Country:US
Mailing Address - Phone:706-243-4594
Mailing Address - Fax:706-243-4596
Practice Address - Street 1:2300 MANCHESTER EXPY
Practice Address - Street 2:STE C001
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6802
Practice Address - Country:US
Practice Address - Phone:706-243-4594
Practice Address - Fax:706-243-4596
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN112041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003113112Medicaid
GA20250I0976OtherMEDICARE PTAN