Basic Information
| Provider Information | |||||||||
| NPI: | 1972720415 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREY-MCBRIDE | ||||||||
| FirstName: | MONIQUE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GREY | ||||||||
| OtherFirstName: | MONIQUE | ||||||||
| OtherMiddleName: | A | ||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3650 STEVE REYNOLDS BLVD | ||||||||
| Address2: | DEPARTMENT OF ORTHOPEDICS, KAISER GWINNETT MEDICAL CTR | ||||||||
| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300964506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043650966 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3650 STEVE REYNOLDS BLVD | ||||||||
| Address2: | DEPARTMENT OF ORTHOPEDICS, KAISER GWINNETT MEDICAL CTR | ||||||||
| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300964506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043650966 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2007 | ||||||||
| LastUpdateDate: | 02/25/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | ME98332 | FL | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 071236 | GA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.