MEDICARE: CYDNEY GRANT D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	E-13179	AR

General Provider Information

NPI Number	:	1164884250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYDNEY GRANT D.O.

Provider Business Mailing Address
First Line	:	PO BOX 251970
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72225-1970
Country	:	US
Telephone Number	:	501-666-8686
Fax Number	:	501-974-7798

Provider Business Practice Location Address
First Line	:	1521 MERRILL DR STE 200
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-1821
Country	:	US
Telephone Number	:	501-660-6893
Fax Number	:	501-974-7798

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2016
Last Update Date	:	09/30/2020

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