Provider Demographics
NPI:1972125847
Name:INVICTUS CLINIC
Entity type:Organization
Organization Name:INVICTUS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:CY
Authorized Official - Last Name:GRINAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-580-0979
Mailing Address - Street 1:1545 POWERS FERRY RD SE STE 120
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-9401
Mailing Address - Country:US
Mailing Address - Phone:770-580-0979
Mailing Address - Fax:678-383-6735
Practice Address - Street 1:1545 POWERS FERRY RD SE STE 120
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-9401
Practice Address - Country:US
Practice Address - Phone:770-580-0979
Practice Address - Fax:678-383-6735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-13
Last Update Date:2024-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy