Healthcare Provider Details

I. General information

NPI: 1770052052
Provider Name (Legal Business Name): JULIE ANN GRANT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 SUGARLOAF PKWY STE 230
DULUTH GA
30097-4936
US

IV. Provider business mailing address

6397 LEE HWY STE 300
CHATTANOOGA TN
37421-2564
US

V. Phone/Fax

Practice location:
  • Phone: 770-814-3900
  • Fax: 770-814-3009
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA004132
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: