Jack Holland Grisham, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

000669 Issued in GA

Practice address

122 Cherry St NE
Marietta, GA 30060-7206

Phone

(770) 427-2911

Fax

(770) 422-2302

NPI assigned

Jan 10, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376692061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 CHERRY ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607206",
            "telephone_number": "770-427-2911",
            "fax_number": "770-422-2302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 CHERRY ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607206",
            "telephone_number": "770-427-2911",
            "fax_number": "770-422-2302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRISHAM",
        "first_name": "JACK",
        "middle_name": "HOLLAND",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "GA",
            "license": "000669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bruno Grillo, PA-C
• Bennett Douglas Grimm, MD
• Jennifer Grimm, PA-C
• Brandon Cy Grinage, M.D.
• Joel A Gripshover, DC
• Darrell Grizzle, L.P.C.
• Nicholas Groene, RBT
• Jamie Lynn Bosma Groh, D.O.
• Karleigh Brooke Grondin
• Mark Daniel Gronsbell, M.D.

• Psychologist in Marietta, GA
• Providers in Marietta, GA by specialty
• Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.