Individual
MS. TINA M. GRALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1045 SOUTHCREST DR, SUITE 200, STOCKBRIDGE, GA 30281-6113
(678) 289-0549
(678) 289-8756
Mailing address
1835 SAVOY DR, SUITE 300, ATLANTA, GA 30341-1072
(678) 289-0549
(678) 289-8756
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN060199
GA
363LF0000X
Family Nurse Practitioner
RN060199
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003185368A
—
GA
05
—
003185368B
—
GA
01
—
202I504936
MEDICARE PTAN
GA
Enumeration date
01/20/2017
Last updated
09/01/2020
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