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General NPI Number Information
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NPI Number | 1235092503
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Entity Type | Individual
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Provider Name | GRISELDA GALLAGHER RN
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Gender | Female
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 1105 N MAIN ST NW
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City | CONYERS
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State | GA
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Zip | 30012-4352
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Country | US
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Telephone | 770-761-8889
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Fax | 770-761-0855
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Provider Business Mailing Address
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Address Line | 140 MARBROOK TRCE
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City | OXFORD
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State | GA
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Zip | 30054-2746
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Country | US
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Telephone | 770-761-8889
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Fax | 770-761-0855
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN253985
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License Number State | GA
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