Provider Demographics
NPI:1114910486
Name:GRANT, G. GARTH (CRNA)
Entity Type:Individual
Prefix:MR
First Name:G.
Middle Name:GARTH
Last Name:GRANT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 696
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-0696
Mailing Address - Country:US
Mailing Address - Phone:440-729-8228
Mailing Address - Fax:888-729-8131
Practice Address - Street 1:8251 MAYFIELD RD
Practice Address - Street 2:SUITE 23
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-2547
Practice Address - Country:US
Practice Address - Phone:440-729-8228
Practice Address - Fax:888-729-8131
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH143833367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0611645Medicaid
OHGR8232902Medicare ID - Type Unspecified