Individual
PRISCELLA GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
320 LANIER AVE W STE 200, FAYETTEVILLE, GA 30214-7443
(770) 250-7477
Mailing address
3105 ABBEY DR SW, ATLANTA, GA 30331-5477
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
PHCP010616
GA
164W00000X
Licensed Practical Nurse
PHCP010616
GA
208000000X
Pediatrics Physician
PHCP010616
GA
251E00000X
Home Health Agency
Primary
—
—
251J00000X
Nursing Care Agency
—
—
374U00000X
Home Health Aide
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003227891A
—
GA
Enumeration date
09/09/2022
Last updated
09/09/2022
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