Healthcare Provider Details

I. General information

NPI: 1710985122
Provider Name (Legal Business Name): MARION WILLIAM GRANT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2005
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403A HIGHWAY 43 S
SARALAND AL
36571-2812
US

IV. Provider business mailing address

PO BOX 7627
MOBILE AL
36670-0627
US

V. Phone/Fax

Practice location:
  • Phone: 251-679-9300
  • Fax: 251-679-9300
Mailing address:
  • Phone: 251-633-7211
  • Fax: 251-633-7367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number00020575
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: