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General NPI Number Information
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NPI Number | 1306957964
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Entity Type | Individual
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Provider Name | LISA GRANVILLE MD
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 4449 MEANDERING WAY FSU SENIORHEALTH AT WOK
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5740
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Country | US
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Telephone | 850-645-1543
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Fax | 850-645-0577
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Provider Business Mailing Address
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Address Line | 4449 MEANDERING WAY
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5740
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Country | US
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Telephone | 850-645-6575
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Fax | 552-307-4028
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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 | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | ME56231
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License Number State | FL
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