Provider Demographics
NPI:1639745425
Name:GROOMS, KESHUANA LESHAY
Entity Type:Individual
Prefix:
First Name:KESHUANA
Middle Name:LESHAY
Last Name:GROOMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 SAINT MARYS RD LOT A61
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-4588
Mailing Address - Country:US
Mailing Address - Phone:229-288-6892
Mailing Address - Fax:
Practice Address - Street 1:3536 SAINT MARYS RD LOT A61
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-4588
Practice Address - Country:US
Practice Address - Phone:229-288-6892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management