Provider Demographics
NPI:1669289229
Name:GRADY, CATHY MONIQUE (RN)
Entity type:Individual
Prefix:MS
First Name:CATHY
Middle Name:MONIQUE
Last Name:GRADY
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 1:670 S GRAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-6268
Mailing Address - Country:US
Mailing Address - Phone:678-599-0538
Mailing Address - Fax:
Practice Address - Street 1:2321 4TH ST STE 210
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-8516
Practice Address - Country:US
Practice Address - Phone:770-837-0673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
GARN177576163WC1500X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health