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General NPI Number Information
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NPI Number | 1992624803
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Entity Type | Individual
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Provider Name | MADISON PRATHER GRANT
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Gender | Female
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Dates
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Enumeration Date | 07/14/2026
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Last Update Date | 07/14/2026
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Provider Practice Location Address
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Address Line | 2795 MAIN ST W UNIT 18
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City | SNELLVILLE
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State | GA
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Zip | 30078-3164
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Country | US
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Telephone | 770-985-2050
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Fax |
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Provider Business Mailing Address
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Address Line | 702 W HIGHTOWER TRL
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City | SOCIAL CIRCLE
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State | GA
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Zip | 30025-3902
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Country | US
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Telephone | 770-298-2658
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | GA
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