Provider Demographics
NPI:1073896775
Name:GRANT, TANYA PARRISH
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:PARRISH
Last Name:GRANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 SIX FORKS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6458
Mailing Address - Country:US
Mailing Address - Phone:919-845-3355
Mailing Address - Fax:919-845-7707
Practice Address - Street 1:6900 SIX FORKS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6458
Practice Address - Country:US
Practice Address - Phone:919-845-3355
Practice Address - Fax:919-845-7707
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies