Individual
MRS. GRACELYN AMBRISTER DENEUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3755 SIXES RD, CANTON, GA 30114-7842
(404) 395-0890
(470) 299-9936
Mailing address
5009 TIWANAKU DR SW, ATLANTA, GA 30331-7999
(404) 349-0844
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN128736
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
049164407
DRIVERS LICENSE
GA
Enumeration date
05/14/2018
Last updated
03/16/2021
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