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General NPI Number Information
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NPI Number | 1639770027
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Entity Type | Individual
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Provider Name | MARKESHA LESHEA GROOMES
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Gender | Female
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Dates
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Enumeration Date | 11/03/2020
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 208 N CUTHBERT ST
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City | COLQUITT
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State | GA
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Zip | 39837-3517
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Country | US
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Telephone | 229-758-3304
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Fax |
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Provider Business Mailing Address
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Address Line | 209 N. CUTHBERT
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City | COLQUITT
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State | GA
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Zip | 39837-3515
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Country | US
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Telephone | 229-758-3385
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Fax | 229-758-2668
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN251952
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License Number State | GA
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