Provider Demographics
NPI:1013697549
Name:GRESHAM, SASHA (CNA)
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:GRESHAM
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 GREENBRIAR CT SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-4214
Mailing Address - Country:US
Mailing Address - Phone:470-610-9429
Mailing Address - Fax:
Practice Address - Street 1:181 GREENBRIAR CT SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-4214
Practice Address - Country:US
Practice Address - Phone:470-610-9429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0030076414376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide