Healthcare Provider Details

I. General information

NPI: 1972338937
Provider Name (Legal Business Name): ANDREA GRIEGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2024
Last Update Date: 09/07/2024
Certification Date: 09/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 MERCER UNIVERSITY DR
ATLANTA GA
30341-4115
US

IV. Provider business mailing address

2373 OXBOW CIR
SMOKE RISE GA
30087-1218
US

V. Phone/Fax

Practice location:
  • Phone: 800-637-2378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: