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Contact Information

GRADY K BACCUS, PhD
2021 E DUBLIN GRANVILLE RD
SUITE 169
COLUMBUS, OH43229-3568
 Phone: 614-888-5133
 Fax: 614-888-8331
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for GRADY K BACCUS · (Male)

NPI # 1811097561
Status Active
Credentials PhD
Entity Individual
Enumeration date 09/23/2006
Last updated 07/09/2007 - About 19 years ago
Sole proprietor 1 Yes
Identifiers
  • OH License # 4269
  • OH Medicaid 0819547
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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