Healthcare Provider Details

I. General information

NPI: 1548182470
Provider Name (Legal Business Name): GRANT CHARLES ELLIOTT APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1063 NATHAN DEAN BYP
ROCKMART GA
30153-2011
US

IV. Provider business mailing address

47 WHITLEY XING
ROCKMART GA
30153-1100
US

V. Phone/Fax

Practice location:
  • Phone: 706-236-4950
  • Fax:
Mailing address:
  • Phone: 706-844-4346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP302868
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: