Provider Demographics
NPI:1154315893
Name:GRANT, JAMES W (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:GRANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 7200
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0200
Mailing Address - Country:US
Mailing Address - Phone:252-937-0200
Mailing Address - Fax:252-451-0056
Practice Address - Street 1:91 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-9590
Practice Address - Country:US
Practice Address - Phone:252-451-3100
Practice Address - Fax:252-937-3106
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC268252080P0202X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1563457OtherCIGNA HEALTHCARE
NC259126OtherUNITED HEALTH CARE
NC7936770Medicaid
NC36770OtherBCBSNC
NC370007244OtherRAILROAD MEDICARE
NC5541070OtherAETNA
NC66487OtherMEDCOST