Healthcare Provider Details

I. General information

NPI: 1659921625
Provider Name (Legal Business Name): CHARMAINE P GRANT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 JOHNSON FERRY RD STE 600
ATLANTA GA
30342-1739
US

IV. Provider business mailing address

1835 SAVOY DR STE 300
ATLANTA GA
30341-1071
US

V. Phone/Fax

Practice location:
  • Phone: 404-256-4777
  • Fax: 404-256-5515
Mailing address:
  • Phone: 678-288-9555
  • Fax: 678-288-9556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN251649
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN251649
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: