Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 13138 | GA |
NPI | 1063403236 |
---|---|
Provider Name | Dr. John R Grant |
First Address | Albany, GA 31721-1514 |
Second Address | Albany, GA 31721-1514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 06/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000039718A | (05) | GA |
D40003 | (02) | GA |