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General NPI Number Information
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NPI Number | 1902622202
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Entity Type | Individual
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Provider Name | GRETTA GOINES ALEXANDER FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 175 COUNTRY CLUB DR
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-9054
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Country | US
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Telephone | 800-410-4663
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Fax |
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Provider Business Mailing Address
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Address Line | 1640 FUMA LEAF WAY
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City | MCDONOUGH
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State | GA
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Zip | 30253-1948
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Country | US
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Telephone | 229-520-1347
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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 | 163WH1000X
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Taxonomy Name | Hospice Registered Nurse
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License Number | RN176479
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN176479
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License Number State | GA
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