Provider Demographics
NPI:1972211662
Name:GRAY-POPOOLA, DELVIOLA (MA BA PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:DELVIOLA
Middle Name:
Last Name:GRAY-POPOOLA
Suffix:
Gender:F
Credentials:MA BA PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 BRIDGES WAY
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-3187
Mailing Address - Country:US
Mailing Address - Phone:770-882-4607
Mailing Address - Fax:678-660-3325
Practice Address - Street 1:305 BRIDGES WAY
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-3187
Practice Address - Country:US
Practice Address - Phone:770-882-4607
Practice Address - Fax:678-660-3325
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN133149163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse