Individual
GRACE KOUCHERAVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3720 DAVINCI CT, SUITE 400, NORCROSS, GA 30092-7627
(770) 582-3992
Mailing address
3720 DAVINCI COURT, STE 400, NORCROSS, GA 30092
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN105205
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7789661
—
VA
Enumeration date
01/19/2006
Last updated
11/18/2015
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