Mark Leslie Grogan

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA4334 Issued in MS

Practice address

401 Baptist Dr
Suite 306
Madison, MS 39110-2009

Phone

(601) 607-7204

Fax

(601) 607-7430

NPI assigned

Jan 11, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1294704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294704000000",
    "number": "1811292501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 BAPTIST DR",
            "address_2": "SUITE 306",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391102009",
            "telephone_number": "601-607-7204",
            "fax_number": "601-607-7430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 BAPTIST DR",
            "address_2": "SUITE 306",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391102009",
            "telephone_number": "601-607-7204",
            "fax_number": "601-607-7430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROGAN",
        "first_name": "MARK",
        "middle_name": "LESLIE",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-01-11",
        "last_updated": "2011-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MS",
            "license": "PTA4334",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "640881013",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0220392",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephen Charles Greer II DMD, D.M.D
• Claire Dornbusch Griner, D.M.D.
• Heatherly Henson Grissom, D.M.D.
• Jason Scott Grissom, D.M.D.
• Lindsey Morgan Groce
• Larry J Grubbs, LCSW
• Rachel Gunalda
• Michelle Guy, LPC, NCC
• Suzanne Haley, SLP
• Breda Faye Hall, LPCC

• Physical Therapy Assistant in Madison, MS
• Providers in Madison, MS by specialty
• Physical Therapy Assistant in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2011; 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.