Provider Demographics
NPI:1821629197
Name:CRAVEY, GLORIA LEE
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:LEE
Last Name:CRAVEY
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 1:1200 FOUNTAIN PARK CIR STE 9
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4859
Mailing Address - Country:US
Mailing Address - Phone:912-602-1009
Mailing Address - Fax:855-938-2292
Practice Address - Street 1:1200 FOUNTAIN PARK CIR STE 9
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4859
Practice Address - Country:US
Practice Address - Phone:912-602-1009
Practice Address - Fax:855-938-2292
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9444806163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy