Provider Demographics
NPI:1003016700
Name:GRANT, ALISSA MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:MICHELLE
Last Name:GRANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 HIGHWAY 71 N
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-4304
Mailing Address - Country:US
Mailing Address - Phone:479-394-5439
Mailing Address - Fax:479-394-4357
Practice Address - Street 1:900 HIGHWAY 71 N
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-4304
Practice Address - Country:US
Practice Address - Phone:479-394-5439
Practice Address - Fax:479-394-4357
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-7744208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics