Provider Demographics
NPI:1053787820
Name:GRINDLER, ELIZABETH
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GRINDLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:G
Other - Last Name:BLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1779 ALDERMAN RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLET
Mailing Address - State:GA
Mailing Address - Zip Code:30415-8236
Mailing Address - Country:US
Mailing Address - Phone:912-682-9976
Mailing Address - Fax:
Practice Address - Street 1:1779 ALDERMAN RD
Practice Address - Street 2:
Practice Address - City:BROOKLET
Practice Address - State:GA
Practice Address - Zip Code:30415-8236
Practice Address - Country:US
Practice Address - Phone:912-682-9976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator