Healthcare Provider Details

I. General information

NPI: 1073292991
Provider Name (Legal Business Name): GRACEFUL TOUCH HEALTHCARE PROVIDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 KRISTY LN
SUMMERVILLE GA
30747-6786
US

IV. Provider business mailing address

35 KRISTY LN
SUMMERVILLE GA
30747-6786
US

V. Phone/Fax

Practice location:
  • Phone: 770-547-1200
  • Fax:
Mailing address:
  • Phone: 770-547-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARSHA D WATSON
Title or Position: NURSE PRACTITIONER/OWNER
Credential: FNP-C
Phone: 770-547-1200