Individual
TANGELA RENORDA GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
753 CREEK BOTTOM RD, LOGANVILLE, GA 30052-6667
(678) 939-4744
Mailing address
753 CREEK BOTTOM RD, LOGANVILLE, GA 30052-6667
(678) 939-4744
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
PHCP011623
GA
Other
Enumeration date
05/20/2024
Last updated
05/20/2024
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