Provider Demographics
NPI:1295510410
Name:STOCKWELL, GRACE CRONIN
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:CRONIN
Last Name:STOCKWELL
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 1:3133 GALANGALE WAY
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30340-4624
Mailing Address - Country:US
Mailing Address - Phone:678-346-8885
Mailing Address - Fax:
Practice Address - Street 1:3133 GALANGALE WAY
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30340-4624
Practice Address - Country:US
Practice Address - Phone:678-346-8885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant