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General NPI Number Information
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NPI Number | 1508279837
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Entity Type | Individual
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Provider Name | EBONEE GRESHAM FNP
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Gender | Female
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Dates
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Enumeration Date | 06/04/2014
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Last Update Date | 04/16/2026
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Provider Practice Location Address
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Address Line | 4280 MEMORIAL DR STE D
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City | DECATUR
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State | GA
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Zip | 30032-1216
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Country | US
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Telephone | 678-719-5525
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 257
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City | GRAYSON
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State | GA
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Zip | 30017-0005
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Country | US
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Telephone | 678-719-5525
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 121515
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 232368
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041577002
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP232368
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 202205404
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License Number State | OR
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Taxonomy #6
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95291307
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License Number State | CA
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Taxonomy #7
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 924955
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License Number State | NY
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