Provider Demographics
NPI:1073714580
Name:GRANGER, JAMES R III (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:GRANGER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1521 JOHNSON FERRY RD STE 135
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6408
Mailing Address - Country:US
Mailing Address - Phone:678-247-2115
Mailing Address - Fax:404-393-8059
Practice Address - Street 1:1521 JOHNSON FERRY RD STE 135
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6408
Practice Address - Country:US
Practice Address - Phone:678-247-2115
Practice Address - Fax:404-393-8059
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA55824208D00000X, 207QA0401X, 208VP0000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology