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General NPI Number Information
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NPI Number | 1710985122
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Entity Type | Individual
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Provider Name | MARION WILLIAM GRANT M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2005
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Last Update Date | 03/25/2008
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Provider Practice Location Address
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Address Line | 403A HIGHWAY 43 S
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City | SARALAND
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State | AL
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Zip | 36571-2812
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Country | US
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Telephone | 251-679-9300
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Fax | 251-679-9300
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Provider Business Mailing Address
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Address Line | PO BOX 7627
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City | MOBILE
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State | AL
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Zip | 36670-0627
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Country | US
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Telephone | 251-633-7211
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Fax | 251-633-7367
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 00020575
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License Number State | AL
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