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General NPI Number Information
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NPI Number | 1427709054
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Entity Type | Individual
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Provider Name | TASHUA LASHUN GRIZZLE RN
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Gender | Female
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Dates
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Enumeration Date | 01/14/2022
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Last Update Date | 01/14/2022
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Provider Practice Location Address
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Address Line | 4131 MERLE CT
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City | MCDONOUGH
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State | GA
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Zip | 30252-8125
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Country | US
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Telephone | 678-772-0830
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Fax |
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Provider Business Mailing Address
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Address Line | 4131 MERLE CT
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City | MCDONOUGH
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State | GA
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Zip | 30252-8125
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Country | US
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Telephone | 678-772-0830
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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 | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number | NHA004969
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | RN29755
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License Number State | GA
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