Provider Demographics
NPI:1538180179
Name:NEIL K GROFF MD LLC
Entity type:Organization
Organization Name:NEIL K GROFF MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:K
Authorized Official - Last Name:GROFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-554-4717
Mailing Address - Street 1:115 LEE BYRD RD
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-2310
Mailing Address - Country:US
Mailing Address - Phone:770-554-4717
Mailing Address - Fax:770-554-4681
Practice Address - Street 1:115 LEE BYRD RD
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-2310
Practice Address - Country:US
Practice Address - Phone:770-554-4717
Practice Address - Fax:770-554-4681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038504207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADD6647OtherMEDICARE RAILROAD
GADD6647OtherMEDICARE RAILROAD