Healthcare Provider Details

I. General information

NPI: 1194729772
Provider Name (Legal Business Name): HUGH JUDD GRANT JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 LAKE BOONE TRL STE 210
RALEIGH NC
27607-7505
US

IV. Provider business mailing address

4414 LAKE BOONE TRL STE 210
RALEIGH NC
27607-7513
US

V. Phone/Fax

Practice location:
  • Phone: 919-571-1040
  • Fax: 919-781-0247
Mailing address:
  • Phone: 919-571-1040
  • Fax: 919-781-0247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number16368
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: