Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 032570 | GA |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 2015-00684 | NC |
NPI | 1124189600 |
---|---|
Provider Name | Dr. Jacqueline H Grant |
First Address | Chapel Hill, NC 27599-7516 |
Second Address | Columbus, GA 31901-3703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 07/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
695415663A | (05) | GA |
BG3220869 | DEA REGISTRATION # (01) | GA |