Individual
TASHUA LASHUN GRIZZLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4131 MERLE CT, MCDONOUGH, GA 30252-8125
(678) 772-0830
Mailing address
4131 MERLE CT, MCDONOUGH, GA 30252-8125
(678) 772-0830
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
RN29755
GA
376G00000X
Nursing Home Administrator
NHA004969
GA
Other
Enumeration date
01/14/2022
Last updated
01/14/2022
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