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General NPI Number Information
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NPI Number | 1467221036
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Entity Type | Individual
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Provider Name | STEVEN KELLY GRANGER
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Gender | Male
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Dates
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Enumeration Date | 12/25/2023
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Last Update Date | 12/25/2023
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Provider Practice Location Address
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Address Line | 465 PONDEROSA DR
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City | THOMASTON
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State | GA
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Zip | 30286-1356
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Country | US
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Telephone | 470-296-5608
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Fax |
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Provider Business Mailing Address
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Address Line | 465 PONDEROSA DR
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City | THOMASTON
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State | GA
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Zip | 30286
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Country | US
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Telephone | 470-296-5608
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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 | 101200000X
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Taxonomy Name | Drama Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251C2600X
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Taxonomy Name | Cardiopulmonary Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 102X00000X
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Taxonomy Name | Poetry Therapist
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License Number |
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License Number State |
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