Healthcare Provider Details

I. General information

NPI: 1477485175
Provider Name (Legal Business Name): GRACE WITHIN HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 COMMERCE BLVD STE A18
RIVERDALE GA
30296-7193
US

IV. Provider business mailing address

804 COMMERCE BLVD STE A18
RIVERDALE GA
30296-7193
US

V. Phone/Fax

Practice location:
  • Phone: 404-316-6434
  • Fax: 855-538-1495
Mailing address:
  • Phone: 404-316-6434
  • Fax: 855-538-1495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CRISTY WEEMS WEEMS
Title or Position: OWNER/PROVIDER
Credential: FNP-C
Phone: 404-316-6434