Provider Demographics
NPI:1871526715
Name:EARLY, ANN GRAGG (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:GRAGG
Last Name:EARLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 1620
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2247
Mailing Address - Country:US
Mailing Address - Phone:404-885-7701
Mailing Address - Fax:404-885-7777
Practice Address - Street 1:1955 CLIFF VALLEY WAY NE
Practice Address - Street 2:SUITE 120
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2476
Practice Address - Country:US
Practice Address - Phone:404-633-0664
Practice Address - Fax:404-633-0857
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA30051207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00576826CMedicaid
GAF15285Medicare UPIN
GA22BDCJKMedicare PIN
GA22BDDQPMedicare PIN