Provider Demographics
NPI:1275146458
Name:GRANT TELEPSYCHIATRY FOR WOMEN, LLC
Entity Type:Organization
Organization Name:GRANT TELEPSYCHIATRY FOR WOMEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TSHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:888-980-9166
Mailing Address - Street 1:13051 ABERCORN ST STE B3-720
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1954
Mailing Address - Country:US
Mailing Address - Phone:912-344-5944
Mailing Address - Fax:
Practice Address - Street 1:13051 ABERCORN ST STE B3-720
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1954
Practice Address - Country:US
Practice Address - Phone:888-980-9166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Multi-Specialty