Healthcare Provider Details

I. General information

NPI: 1942815717
Provider Name (Legal Business Name): VALERIE RENEE' GRENALD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 09/14/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E. HOSPITAL RD
FORT GORDON GA
30905
US

IV. Provider business mailing address

300 E HOSPITAL RD
FORT GORDON GA
30905
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-9399
  • Fax:
Mailing address:
  • Phone: 706-787-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN246874
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: