Provider Demographics
NPI:1174288344
Name:GROVES, JONISHA
Entity type:Individual
Prefix:
First Name:JONISHA
Middle Name:
Last Name:GROVES
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 1:1062 MCCONAUGHY CT
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6791
Mailing Address - Country:US
Mailing Address - Phone:937-838-6067
Mailing Address - Fax:
Practice Address - Street 1:1062 MCCONAUGHY CT
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6791
Practice Address - Country:US
Practice Address - Phone:937-838-6067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist