Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 0116025753 | VA |
N | 208600000X | Surgeon | 0116025753 | VA |
N | 208200000X | Surgeon | 86237 | GA |
N | 208600000X | Surgeon | 86237 | GA |
Y | 2086S0129X | Vascular Surgeon | 86237 | GA |
NPI | 1033557459 |
---|---|
Provider Name | Courtney L Grant |
First Address | Atlanta, GA 30374-2616 |
Second Address | Gainesville, GA 30501-3834 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2013 |
Last Update Date | 07/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003235364A | (05) | GA |
003235364B | (05) | GA |
003235364C | (05) | GA |
003235364D | (05) | GA |
003235364E | (05) | GA |
003235364F | (05) | GA |
003235364G | (05) | GA |
003235364H | (05) | GA |