Provider Demographics
NPI:1174870240
Name:WARREN, GLORIA (NURSING AIDE)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:NURSING AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7710 TREE MOUNTAIN PKWY
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-6745
Mailing Address - Country:US
Mailing Address - Phone:770-912-1023
Mailing Address - Fax:
Practice Address - Street 1:7710 TREE MOUNTAIN PKWY
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-6745
Practice Address - Country:US
Practice Address - Phone:770-912-1023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028896438376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide