MEDICARE: R PEERY GRANT MD PC

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	10945	GA

General Provider Information

NPI Number	:	1841489127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R PEERY GRANT MD PC

Provider Business Mailing Address
First Line	:	1493 LAVISTA ROAD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30324-3846
Country	:	US
Telephone Number	:	404-325-5733
Fax Number	:	404-325-5733

Provider Business Practice Location Address
First Line	:	1493 LAVISTA ROAD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30324-3846
Country	:	US
Telephone Number	:	404-325-5733
Fax Number	:	404-325-5733

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RALPH PERRY GRANT
Credential	:	MD
Telephone Number	:	404-325-5733

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	10/23/2007

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