Healthcare Provider Details

I. General information

NPI: 1194111666
Provider Name (Legal Business Name): GRANT PATRICK SAXTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2015
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 JEFFERSON STREET SUITE 200
LAUREL MS
39440-4306
US

IV. Provider business mailing address

205 DEER HAVEN DR
MADISON MS
39110-8079
US

V. Phone/Fax

Practice location:
  • Phone: 601-649-3520
  • Fax: 601-649-7899
Mailing address:
  • Phone: 601-955-9896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number25595
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: