Individual
VIRGINIA GRANTHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, BSN, IBCLC
Contact information
Practice address
511 ANNSLEE LN, LOGANVILLE, GA 30052-7236
(706) 490-2310
Mailing address
511 ANNSLEE LN, LOGANVILLE, GA 30052-7236
(706) 490-2310
Taxonomy
Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
RN205137
GA
Other
Enumeration date
09/16/2024
Last updated
09/16/2024
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