Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 25595 | MS |
NPI | 1194111666 |
---|---|
Provider Name | Dr. Grant Patrick Saxton |
First Address | Madison, MS 39110-8079 |
Second Address | Laurel, MS 39440-4306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2015 |
Last Update Date | 08/01/2020 |