MEDICARE: ELIZABETH HEATH ANDERSON GRANTHAM FNP

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
1	363LF0000X	Family Nurse Practitioner	363LF0000X	SC

General Provider Information

NPI Number	:	1568798007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH HEATH ANDERSON GRANTHAM FNP

Provider Business Mailing Address
First Line	:	PO BOX 751649
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1649
Country	:	US
Telephone Number	:	843-789-1620
Fax Number	:	843-724-2440

Provider Business Practice Location Address
First Line	:	3510 HIGHWAY 17 N
Second Line	:	SUITE 110
City	:	MT PLEASANT
State	:	SC
Zip	:	29466-8227
Country	:	US
Telephone Number	:	843-606-8960
Fax Number	:	843-606-8961

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2009
Last Update Date	:	10/19/2015

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