Basic Information
| Provider Information | |||||||||
| NPI: | 1104823145 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GROSSMAN | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5555 PEACHTREE DUNWOODY RD NE | ||||||||
| Address2: | SUITE G-99 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048433323 | ||||||||
| FaxNumber: | 4047950780 | ||||||||
| Practice Location | |||||||||
| Address1: | 5555 PEACHTREE DUNWOODY RD NE | ||||||||
| Address2: | SUITE G-99 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048433323 | ||||||||
| FaxNumber: | 4047950780 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2005 | ||||||||
| LastUpdateDate: | 05/20/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | 46109 | GA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00055192 | 01 | MEDICARE RR | OTHER | 7085282 | 01 | AETNA | OTHER | 702813 | 01 | GA | BLUE CROSS BLUE SHIELD GA | OTHER |