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General NPI Number Information
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NPI Number | 1033975420
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Entity Type | Organization
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Legal Business Name | GRANT FAMILY MEDICAL LLC
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Dates
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Enumeration Date | 02/23/2024
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Last Update Date | 02/23/2024
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Provider Practice Location Address
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Address Line | 805 VARSITY DR
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City | TUPELO
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State | MS
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Zip | 38801-4615
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Country | US
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Telephone | 484-252-6707
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Fax |
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Provider Business Mailing Address
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Address Line | 206 MAYNARD DR
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City | TUPELO
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State | MS
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Zip | 38801-4324
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Country | US
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Telephone | 484-252-6707
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Fax |
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Authorized Official
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Title or Position | OWNER/NURSE PRACTITIONER
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Name | MS. DANA L GRANT
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Credential | NP-C
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Telephone | 484-252-6707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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