Individual
CONNIE GRESHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
180 WATER OAK DR, CEDARTOWN, GA 30125-2095
(706) 270-5033
Mailing address
1401 APPLEWOOD DR STE 1, DALTON, GA 30720-2699
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN031192
GA
Other
Enumeration date
09/25/2018
Last updated
09/25/2018
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