Provider Demographics
NPI:1215099908
Name:GRIGSBY, MARY VIRGINIA (MS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:VIRGINIA
Last Name:GRIGSBY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 WOODLAND BROOK LN SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-7071
Mailing Address - Country:US
Mailing Address - Phone:404-606-2795
Mailing Address - Fax:404-352-3851
Practice Address - Street 1:2701 WOODLAND BROOK LN SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-7071
Practice Address - Country:US
Practice Address - Phone:404-606-2795
Practice Address - Fax:404-352-3851
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00969779AMedicaid