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General NPI Number Information
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NPI Number | 1023017795
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Entity Type | Individual
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Provider Name | CATHERINE CORISH GRANT PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/15/2005
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 60 EXCHANGE STREET SUITE B-7
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City | RICHMOND HILL
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State | GA
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Zip | 31324
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Country | US
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Telephone | 912-756-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 114 GREAT OAKS WAY
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City | RICHMOND HILL
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State | GA
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Zip | 31324-5461
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Country | US
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Telephone | 912-596-8868
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 004290
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License Number State | GA
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