Individual
NICOLE GRANT BONDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
106 SHOPPERS WAY STE 112, BRUNSWICK, GA 31525-0522
(912) 554-3805
Mailing address
303 PINEVIEW DR, WAYCROSS, GA 31501-5229
(912) 283-0777
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP010180
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SLP010180
—
GA
Enumeration date
09/25/2018
Last updated
09/25/2018
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