TEONDRA SHANTAY MCGRUDER


Address: 1032 Lakeview St, Louisville, GA 30434-5963
Phone: 4782062864

TEONDRA SHANTAY MCGRUDER (NPI# 1407320492) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1407320492
Entity Type Individual
Full Name TEONDRA SHANTAY MCGRUDER
Practice Address 1032 Lakeview St
Louisville
GA 30434-5963
Practice Telephone 4782062864
Mailing Telephone 4782062864
Enumeration Date 2019-01-14
Last Update Date 2019-01-14
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 1744P3200X Specialist
Specialization: Prosthetics Case Management
CO131457 GA Other Service Providers

Office Location

Street Address 1032 LAKEVIEW ST
City LOUISVILLE
State GA
Zip Code 30434-5963

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1255503934 Tonya M Gunby Dmd PC Dentist 502 Screven Street, Louisville, GA 30434 2008-04-02
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1659461028 Shirlee T. Johnson Registered Nurse 2501highway 1 N, Louisville, GA 30434 2006-10-13
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1760420202 Andrea Byrd Doak Physician Assistant 1067 Peachtree St, Louisville, GA 30434 2006-06-04
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1467631648 Kimberly J Clarkbrake Registered Nurse 2501 Highway One North, Louisville, GA 30434 2007-10-24
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Taxonomy Information

Taxonomy Code 1744P3200X
Grouping Other Service Providers
Classification Specialist
Specialization Prosthetics Case Management

Taxonomy Definition

Definition to come...

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1386109379 Quintina Love Specialist 3023 Hunsinger Ln Ste A, Louisville, KY 40220-2232 2019-02-05

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NPI Name Taxonomy Address Enumeration
1225638448 Shariyfa Ferron Specialist 1864 Scenic Hwy N Ste 112, Snellville, GA 30078-2549 2020-10-27
1851908016 Takenya Lacole Jordan Specialist 2231 Dawson Rd Ste Ij, Albany, GA 31707-3227 2020-09-30
1437765724 Shanea Buie Specialist 5977 Whitesville Rd Ste 20, Columbus, GA 31904-3618 2020-09-22
1114537313 Kimberly Melissa Sampson Specialist 2386 Clower St Ste 102, Snellville, GA 30078-6134 2020-08-04
1295351302 Marquisha General Specialist 1639 Lower Roswell Rd, Marietta, GA 30068-3343 2020-06-24
1053937805 Angela D Zanders Specialist 1600 E Forsyth St, Americus, GA 31709-3856 2020-06-17
1770107526 Natasha Monic Douglas Specialist 1630 Scenic Hwy N, Snellville, GA 30078-5647 2020-06-07
1518595479 Jacque Monae LLC Specialist 4955 Sugarloaf Pkwy Ste 104, Lawrenceville, GA 30044-8838 2020-03-27
1518592716 Naquiesha Peterson Specialist 3510 Ponderosa Ln, Powder Springs, GA 30127-2074 2020-03-08
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Competitor

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City LOUISVILLE
Zip Code 30434

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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