Healthcare Provider Details

I. General information

NPI: 1407684731
Provider Name (Legal Business Name): EMMA GRANBERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 6TH AVE S
BIRMINGHAM AL
35233-1932
US

IV. Provider business mailing address

1802 6TH AVE S
BIRMINGHAM AL
35233-1932
US

V. Phone/Fax

Practice location:
  • Phone: 205-975-8884
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number57.261044
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: