Individual
MS. JUDY NELL GRAVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
221 BOULEVARD, MONROE, GA 30655
(770) 807-2189
Mailing address
221 BOULEVARD, MONROE, GA 30655
(770) 807-2189
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN057615
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
JG4321
—
GA
Enumeration date
08/08/2011
Last updated
08/08/2011
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