NPI Code Detail JSON Logo

1306715230 NPI number — COLONEL EUGENE GRANT

NPI Number: 1306715230
Health Care Provider/Practitioner: COLONEL EUGENE GRANT

Information about “1306715230” NPI (COLONEL EUGENE GRANT) exists in 1306715230 in HTML format HTML  |  1306715230 in plain Text format TXT  |  1306715230 in PDF (Portable Document Format) PDF  |  1306715230 in an XML format XML  formats.

NPI Number : 1306715230 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1306715230",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GRANT",
    "FirstName": "COLONEL",
    "MiddleName": "EUGENE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2173 EDEN TER APT 310",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROCK HILL",
    "MailingAddressStateName": "SC",
    "MailingAddressPostalCode": "29730-2878",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "704-701-4024",
    "MailingAddressFaxNumber": "704-701-4024",
    "FirstLinePracticeLocationAddress": "2173 EDEN TER APT 310",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ROCK HILL",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29730-2878",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "704-701-4024",
    "PracticeLocationAddressFaxNumber": "704-701-4024",
    "EnumerationDate": "10/30/2025",
    "LastUpdateDate": "10/30/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "172A00000X",
        "TaxonomyName": "Driver",
        "LicenseNumber": "445BKZ",
        "LicenseNumberStateCode": "SC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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