Provider Demographics
NPI:1326490384
Name:GROVES, THERESA ANN (APRN)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:GROVES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5354 JOHNSON SPUR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-2915
Mailing Address - Country:US
Mailing Address - Phone:678-699-9434
Mailing Address - Fax:
Practice Address - Street 1:235 PEACHTREE ST NE
Practice Address - Street 2:SUITE 2100, NORTH TOWER
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-1401
Practice Address - Country:US
Practice Address - Phone:770-994-9326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN216441363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily