Provider Demographics
NPI:1982216503
Name:GRACE MEDICAL ENTREPRISES
Entity type:Organization
Organization Name:GRACE MEDICAL ENTREPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, THD
Authorized Official - Phone:470-489-7917
Mailing Address - Street 1:PO BOX 491232
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30049-0021
Mailing Address - Country:US
Mailing Address - Phone:470-881-2285
Mailing Address - Fax:470-945-4151
Practice Address - Street 1:7544 SOUTHLAKE PKWY STE 102
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2495
Practice Address - Country:US
Practice Address - Phone:470-489-7917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRACE MEDICAL ENTREPRISES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-17
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Multi-Specialty
No177F00000XOther Service ProvidersLodging
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No291U00000XLaboratoriesClinical Medical Laboratory
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1123454OtherCOMMERCIAL
FL365411OtherMULTI-SPECIALTY FACILITY
OH0480262Medicaid