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NPI Code Detail

MEDICARE: DR. STEVEN GRANICH DSW

MEDICARE: DR. STEVEN GRANICH DSW
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
11041C0700XClinical Social Worker883GA

General Provider Information

NPI Number : 1710015672
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEVEN GRANICH DSW
Provider Business Mailing Address
First Line : PO BOX 5328
Second Line :
City : COLUMBUS
State : GA
Zip : 31906-0328
Country : US
Telephone Number : 706-324-7241
Fax Number : 706-324-0027
Provider Business Practice Location Address
First Line : 9067 VETERANS PKWY
Second Line :
City : MIDLAND
State : GA
Zip : 31820-3411
Country : US
Telephone Number : 706-324-7241
Fax Number : 706-324-0027
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2007
Last Update Date : 07/08/2007

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