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General NPI Number Information
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NPI Number | 1245236744
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Entity Type | Individual
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Provider Name | EDWARD KEITH GRANT P.A.
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Gender | Male
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 100 N MACON ST
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City | MACON
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State | GA
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Zip | 31210-6563
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Country | US
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Telephone | 478-200-6970
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 370
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City | FORTSON
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State | GA
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Zip | 31808-0370
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Country | US
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Telephone | 706-494-3171
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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 | 004120
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 4120
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License Number State | GA
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