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General NPI Number Information
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NPI Number | 1417732769
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Entity Type | Individual
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Provider Name | PATRICIA D MCGREW
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Gender | Female
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Dates
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Enumeration Date | 08/25/2023
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Last Update Date | 08/25/2023
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Provider Practice Location Address
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Address Line | 1253 COMMERCIAL DR SW
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City | CONYERS
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State | GA
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Zip | 30094-5987
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Country | US
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Telephone | 770-285-6049
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Fax |
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Provider Business Mailing Address
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Address Line | 1941 CORNERSTONE PASS
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City | CONYERS
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State | GA
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Zip | 30012-3786
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Country | US
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Telephone | 678-522-1099
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | APC008784
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License Number State | GA
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