Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 88490 | GA |
NPI | 1114377207 |
---|---|
Provider Name | Daniel Nathan Grant |
First Address | Rome, GA 30165-1369 |
Second Address | Rome, GA 30165-1625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2016 |
Last Update Date | 03/08/2021 |