Healthcare Provider Details

I. General information

NPI: 1770035248
Provider Name (Legal Business Name): CELISA MCGRONE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 LAKE HEARN DR STE 160
SANDY SPRINGS GA
30342-1572
US

IV. Provider business mailing address

1100 LAKE HEARN DR STE 160
SANDY SPRINGS GA
30342-1572
US

V. Phone/Fax

Practice location:
  • Phone: 888-671-5902
  • Fax: 339-686-3137
Mailing address:
  • Phone: 888-671-5902
  • Fax: 339-686-3137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN232254
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN60790807
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR232956
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60790736
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: