Provider Demographics
NPI:1447018288
Name:GRACIA, GERROD JAMAL
Entity type:Individual
Prefix:
First Name:GERROD
Middle Name:JAMAL
Last Name:GRACIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 EXECUTIVE PARK DR NE APT 2222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2269
Mailing Address - Country:US
Mailing Address - Phone:404-731-8703
Mailing Address - Fax:
Practice Address - Street 1:1525 CLIFTON ROAD NE
Practice Address - Street 2:EMORY STUDENT HEALTH
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:404-727-7551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN284674163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse