Provider Demographics
NPI:1659615342
Name:GAINEY-GRANT, TYRONJALA SHONTEL (PMHNP)
Entity Type:Individual
Prefix:
First Name:TYRONJALA
Middle Name:SHONTEL
Last Name:GAINEY-GRANT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:TYRONJALA
Other - Middle Name:SHONTEL
Other - Last Name:GAINEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:223 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:223 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2640
Practice Address - Country:US
Practice Address - Phone:770-991-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN175270363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health