Healthcare Provider Details

I. General information

NPI: 1205257268
Provider Name (Legal Business Name): GRETA M GILSON AGNEW ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRETA GILSON AGNEW ANP-BC

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 02/06/2022
Certification Date: 02/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 GLENLAKE PARKWAY NE
SANDY SPRINGS GA
30328
US

IV. Provider business mailing address

20 GLENLAKE PARKWAY NE
SANDY SPRINGS GA
30328
US

V. Phone/Fax

Practice location:
  • Phone: 404-365-0966
  • Fax:
Mailing address:
  • Phone: 404-365-0966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN054192
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: