Provider Demographics
NPI:1114366028
Name:GRIGSBY, CHARLES KEVIN (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:KEVIN
Last Name:GRIGSBY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:619 S 8TH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4260
Mailing Address - Country:US
Mailing Address - Phone:770-229-6072
Mailing Address - Fax:757-446-5197
Practice Address - Street 1:619 S 8TH ST STE 301
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4260
Practice Address - Country:US
Practice Address - Phone:770-229-6072
Practice Address - Fax:757-446-5197
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012651202086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ075195Medicaid