Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NP0017X | Pediatric Chiropractor | CHIRO10079 | GA |
NPI | 1942796263 |
---|---|
Provider Name | Dr. Grace Gilbreath |
First Address | Covington, GA 30014-6660 |
Second Address | Covington, GA 30014-6660 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2018 |
Last Update Date | 10/07/2018 |