Individual
EBONEE GRESHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4280 MEMORIAL DR STE D, DECATUR, GA 30032-1216
(678) 719-5525
Mailing address
PO BOX 257, GRAYSON, GA 30017-0005
(678) 719-5525
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041577002
IL
163W00000X
Registered Nurse
121515
HI
163W00000X
Registered Nurse
202205404
OR
163W00000X
Registered Nurse
232368
GA
163W00000X
Registered Nurse
924955
NY
163W00000X
Registered Nurse
95291307
CA
363LF0000X
Family Nurse Practitioner
Primary
NP232368
GA
Other
Enumeration date
06/04/2014
Last updated
04/16/2026
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