Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 55824 | GA |
Y | 208D00000X | General Practice Physician | 55824 | GA |
NPI | 1073714580 |
---|---|
Provider Name | Dr. James R Granger III |
First Address | Marietta, GA 30062-6408 |
Second Address | Marietta, GA 30062-6408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 01/12/2021 |