Healthcare Provider Details

I. General information

NPI: 1922887942
Provider Name (Legal Business Name): SASHA GRANT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 COLONIAL PARK DR STE 100
ROSWELL GA
30075-3839
US

IV. Provider business mailing address

7080 THREADSTONE OVERLOOK
DULUTH GA
30097-7111
US

V. Phone/Fax

Practice location:
  • Phone: 678-439-0017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number337198
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number337198
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: