Provider Demographics
NPI:1386181089
Name:GRALL, TINA M (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:M
Last Name:GRALL
Suffix:
Gender:F
Credentials:FNP-C
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Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:678-289-0549
Mailing Address - Fax:678-289-8756
Practice Address - Street 1:1045 SOUTHCREST DR
Practice Address - Street 2:SUITE 200
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6113
Practice Address - Country:US
Practice Address - Phone:678-289-0549
Practice Address - Fax:678-289-8756
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2020-09-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN060199363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003185368AMedicaid
GA003185368BMedicaid
GA202I504936OtherMEDICARE PTAN