Provider Demographics
NPI:1124366992
Name:GRESHAM, SABINA
Entity type:Individual
Prefix:
First Name:SABINA
Middle Name:
Last Name:GRESHAM
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 1:975 GAINES SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-3133
Mailing Address - Country:US
Mailing Address - Phone:706-549-2289
Mailing Address - Fax:706-549-1177
Practice Address - Street 1:975 GAINES SCHOOL RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-3133
Practice Address - Country:US
Practice Address - Phone:706-549-2289
Practice Address - Fax:706-549-1177
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA109-R-0323376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA896062924BMedicaid
GA896062924EMedicaid
GA829944758AMedicaid
GA896062924DMedicaid
GA896062924AMedicaid
GA262171341AMedicaid