Provider Demographics
NPI:1134433766
Name:LOGAN, GRETTA A (RN)
Entity type:Individual
Prefix:
First Name:GRETTA
Middle Name:A
Last Name:LOGAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4541 BRIGHTS PIKE
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-6714
Mailing Address - Country:US
Mailing Address - Phone:404-290-4737
Mailing Address - Fax:
Practice Address - Street 1:931 INDUSTRIAL PARK RD STE 200
Practice Address - Street 2:
Practice Address - City:DANDRIDGE
Practice Address - State:TN
Practice Address - Zip Code:37725-4701
Practice Address - Country:US
Practice Address - Phone:865-397-3930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000169733163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health