Healthcare Provider Details

I. General information

NPI: 1114910486
Provider Name (Legal Business Name): G. GARTH GRANT C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8251 MAYFIELD RD SUITE 23
CHESTERLAND OH
44026-2547
US

IV. Provider business mailing address

PO BOX 696
CHESTERLAND OH
44026-0696
US

V. Phone/Fax

Practice location:
  • Phone: 440-729-8228
  • Fax: 888-729-8131
Mailing address:
  • Phone: 440-729-8228
  • Fax: 888-729-8131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number143833
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: