Healthcare Provider Details

I. General information

NPI: 1720441504
Provider Name (Legal Business Name): RICHARD LOWELL GRANTIER III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4517 SOUTHLAKE PKWY
HOOVER AL
35244-3280
US

IV. Provider business mailing address

4517 SOUTHLAKE PKWY
HOOVER AL
35244-3280
US

V. Phone/Fax

Practice location:
  • Phone: 205-985-4111
  • Fax:
Mailing address:
  • Phone: 205-985-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberT-3124
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number59053
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number41359
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.41359
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: