Healthcare Provider Details

I. General information

NPI: 1790245819
Provider Name (Legal Business Name): JOSEPH WAYNE GRANADE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2019
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 19TH ST S
BIRMINGHAM AL
35233-1900
US

IV. Provider business mailing address

1025 MOREHEAD MEDICAL DR STE 300
CHARLOTTE NC
28204-2966
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-2490
  • Fax:
Mailing address:
  • Phone: 850-687-0077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMMD.89743
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2026-02526
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number41842
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: