Healthcare Provider Details

I. General information

NPI: 1003965716
Provider Name (Legal Business Name): JANET LENISE MCGRUDER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANET LENISE POPE CAMPBELL RN

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 JOHN E WESLEY AVE
COLLEGE PARK GA
30337
US

IV. Provider business mailing address

99 JESSE HILL JR DRIVE SE
ATLANTA GA
30303
US

V. Phone/Fax

Practice location:
  • Phone: 404-765-4155
  • Fax: 404-765-4149
Mailing address:
  • Phone: 404-730-1217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN127390
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: