Jerry D. Grimes

Primary specialty

Surgical TechnologistTaxonomy code 246ZS0410X

Practice address

705 Whisper TRL
Apt #204B
Austell, GA 30168-7135

Phone

(678) 488-5272

Fax

(770) 723-9352

NPI assigned

Apr 23, 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

Other names 1

• Mr. Jerry D. Grimes Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457579609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 28094",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303580094",
            "telephone_number": "678-488-5272",
            "fax_number": "770-723-9352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 WHISPER TRL",
            "address_2": "APT #204B",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301687135",
            "telephone_number": "678-488-5272",
            "fax_number": "770-723-9352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIMES",
        "first_name": "JERRY",
        "middle_name": "D.",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZS0410X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Technologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JERRY",
            "last_name": "GRIMES",
            "middle_name": "D.",
            "prefix": "MR.",
            "credential": "ORT",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• All providers in Austell, GA
• Surgical Technologist 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.