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NPI Code Detail

MEDICARE: EVAN MICHAEL GRANT MD

MEDICARE: EVAN MICHAEL GRANT MD
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
12084P0800XPsychiatry Physician0101250288VA

General Provider Information

NPI Number : 1841409984
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVAN MICHAEL GRANT MD
Provider Business Mailing Address
First Line : 340 BAGLEY CIR
Second Line : SOUTHWESTERN VIRGINIA MENTAL HEALTH INSTITUTE
City : MARION
State : VA
Zip : 24354-3126
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 340 BAGLEY CIR
Second Line : SOUTHWESTERN VIRGINIA MENTAL HEALTH INSTITUTE
City : MARION
State : VA
Zip : 24354-3126
Country : US
Telephone Number : 276-783-1200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2007
Last Update Date : 02/16/2012

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