Healthcare Provider Details

I. General information

NPI: 1861338980
Provider Name (Legal Business Name): PROMISE HEALTH MEDICAL INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4280 MEMORIAL DR STE D
DECATUR GA
30032-1216
US

IV. Provider business mailing address

4280 MEMORIAL DR STE D
DECATUR GA
30032-1216
US

V. Phone/Fax

Practice location:
  • Phone: 404-941-9270
  • Fax:
Mailing address:
  • Phone: 404-941-9270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. EBONEE GRESHAM
Title or Position: DIRECTOR
Credential: DNP FNP
Phone: 404-941-9270