Provider Demographics
NPI:1033975420
Name:GRANT FAMILY MEDICAL LLC
Entity Type:Organization
Organization Name:GRANT FAMILY MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:484-252-6707
Mailing Address - Street 1:206 MAYNARD DR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4324
Mailing Address - Country:US
Mailing Address - Phone:484-252-6707
Mailing Address - Fax:
Practice Address - Street 1:805 VARSITY DR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4615
Practice Address - Country:US
Practice Address - Phone:484-252-6707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty