Healthcare Provider Details

I. General information

NPI: 1154315893
Provider Name (Legal Business Name): JAMES W GRANT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 ENTERPRISE DR
ROCKY MOUNT NC
27804-9590
US

IV. Provider business mailing address

PO BOX 7200
ROCKY MOUNT NC
27804-0200
US

V. Phone/Fax

Practice location:
  • Phone: 252-451-3100
  • Fax: 252-937-3106
Mailing address:
  • Phone: 252-937-0200
  • Fax: 252-451-0056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number26825
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number26825
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: