Healthcare Provider Details

I. General information

NPI: 1639083231
Provider Name (Legal Business Name): GRANT NON-EMERGENCY MEDICAL TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CHANNING CIR
CANTON MS
39046-5510
US

IV. Provider business mailing address

103 CHANNING CIR
CANTON MS
39046-5510
US

V. Phone/Fax

Practice location:
  • Phone: 601-668-0408
  • Fax:
Mailing address:
  • Phone: 601-668-0408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. DEVON DEWAYNE GRANT
Title or Position: OWNER
Credential: EMS DRIVER
Phone: 601-668-0408