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NPI Code Detail

MEDICARE: CARRIE J GRANT PA-C

MEDICARE: CARRIE J GRANT PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant6488GA

General Provider Information

NPI Number : 1174861058
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARRIE J GRANT PA-C
Provider Business Mailing Address
First Line : 3650 GROVELAND RD
Second Line :
City : OCEAN SPRINGS
State : MS
Zip : 39564-5754
Country : US
Telephone Number : 228-875-0780
Fax Number : 228-875-1009
Provider Business Practice Location Address
First Line : 3650 GROVELAND RD
Second Line :
City : OCEAN SPRINGS
State : MS
Zip : 39564-5754
Country : US
Telephone Number : 228-875-0780
Fax Number : 228-875-1009
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2013
Last Update Date : 08/12/2020

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Directions to “ CARRIE J GRANT PA-C” Practice Location

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