Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0700X | Adult Development & Aging Psychologist | ||
N | 103TH0100X | Health Service |
NPI | 1568958858 |
---|---|
Provider Name | Darian L Grantham |
First Address | Goldsboro, NC 27530-6713 |
Second Address | Goldsboro, NC 27530-6713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2018 |
Last Update Date | 10/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47-3535658 | (05) | NC |