Provider Demographics
NPI:1174861058
Name:GRANT, CARRIE J (PA-C)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:J
Last Name:GRANT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3650 GROVELAND RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5754
Mailing Address - Country:US
Mailing Address - Phone:228-875-0780
Mailing Address - Fax:228-875-1009
Practice Address - Street 1:3650 GROVELAND RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5754
Practice Address - Country:US
Practice Address - Phone:228-875-0780
Practice Address - Fax:228-875-1009
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA6488363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical