Healthcare Provider Details

I. General information

NPI: 1477313658
Provider Name (Legal Business Name): MARY KATHERINE GRANT APRN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 03/22/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 GUNBARREL RD STE 111
CHATTANOOGA TN
37421-3897
US

IV. Provider business mailing address

1511 GUNBARREL RD STE 111
CHATTANOOGA TN
37421-3897
US

V. Phone/Fax

Practice location:
  • Phone: 423-553-5999
  • Fax:
Mailing address:
  • Phone: 423-553-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number35851
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: