Provider Demographics
NPI:1962407957
Name:GROOVER, FAYE LEWIS (OWNER)
Entity type:Individual
Prefix:MS
First Name:FAYE
Middle Name:LEWIS
Last Name:GROOVER
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1487 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31216-5817
Mailing Address - Country:US
Mailing Address - Phone:478-785-9779
Mailing Address - Fax:478-785-9779
Practice Address - Street 1:1487 ALLEN RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31216-5817
Practice Address - Country:US
Practice Address - Phone:478-785-9779
Practice Address - Fax:478-785-9779
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant