Provider Demographics
NPI:1639770027
Name:GROOMES, MARKESHA LESHEA
Entity Type:Individual
Prefix:
First Name:MARKESHA
Middle Name:LESHEA
Last Name:GROOMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARKESHA
Other - Middle Name:LESHEA
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:209 N. CUTHBERT
Mailing Address - Street 2:
Mailing Address - City:COLQUITT
Mailing Address - State:GA
Mailing Address - Zip Code:39837-3515
Mailing Address - Country:US
Mailing Address - Phone:229-758-3385
Mailing Address - Fax:229-758-2668
Practice Address - Street 1:209 N. CUTHBERT
Practice Address - Street 2:
Practice Address - City:COLQUITT
Practice Address - State:GA
Practice Address - Zip Code:39837-3515
Practice Address - Country:US
Practice Address - Phone:229-758-3385
Practice Address - Fax:229-758-2668
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN251952363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily