Provider Demographics
NPI:1487235354
Name:GRIMSLEY, LEEKIESHIA DYONNE (NP)
Entity type:Individual
Prefix:
First Name:LEEKIESHIA
Middle Name:DYONNE
Last Name:GRIMSLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 N POINT PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4102
Mailing Address - Country:US
Mailing Address - Phone:770-442-1911
Mailing Address - Fax:
Practice Address - Street 1:3790 PLEASANT HILL RD STE 170
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5145
Practice Address - Country:US
Practice Address - Phone:707-360-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN312959363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner