Provider Demographics
NPI:1619208717
Name:OGALA, GRACE ISOKEN (NP)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:ISOKEN
Last Name:OGALA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:ISOKEN
Other - Last Name:OGALA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:2030 POWERS FERRY RD SE STE 120
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5016
Mailing Address - Country:US
Mailing Address - Phone:678-801-2329
Mailing Address - Fax:844-249-2637
Practice Address - Street 1:350 AUSTIN GRAYBILL RD
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29860
Practice Address - Country:US
Practice Address - Phone:803-278-4272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN252611363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily