Provider Demographics
NPI:1558340349
Name:MISAKI, GRACE I (NP)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:I
Last Name:MISAKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:770-496-9400
Mailing Address - Fax:770-496-9495
Practice Address - Street 1:4285 JIM MOORE RD STE 200
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1551
Practice Address - Country:US
Practice Address - Phone:770-442-1911
Practice Address - Fax:707-442-0306
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN098265363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000852057EMedicaid
GAP84846Medicare UPIN