Organization
GRN COMMUNITY SERVICE BOARD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHLEEN MARIE SMITH RN, CAC 1 (CLINICIAN)
(678) 377-3746
Entity
Organization
Contact information
Practice address
175 GWINNETT DR, LAWRENCEVILLE, GA 30045-8444
(770) 339-5000
Mailing address
175 GWINNETT DR, LAWRENCEVILLE, GA 30045-8444
(770) 339-5000
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
126437
GA
Other
Enumeration date
12/20/2006
Last updated
08/22/2020
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