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General NPI Number Information
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NPI Number | 1639064181
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Entity Type | Individual
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Provider Name | GRANTLAND SUTTON REVIERE DO
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Gender | Male
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Dates
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Enumeration Date | 06/12/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 4401 RIVERCHASE DR
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City | PHENIX CITY
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State | AL
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Zip | 36867-7483
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Country | US
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Telephone | 334-732-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 7036 SPRING WALK DR
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City | COLUMBUS
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State | GA
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Zip | 31904-2717
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Country | US
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Telephone | 731-217-4433
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 17863
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License Number State | GA
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