Provider Demographics
NPI:1336465251
Name:GRANJA INGRAM, NARA
Entity Type:Individual
Prefix:
First Name:NARA
Middle Name:
Last Name:GRANJA INGRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NARA
Other - Middle Name:VALESCHKA MATOS
Other - Last Name:GRANJA INGRAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1601 23RD AVE SOUTH
Mailing Address - Street 2:SUITE 3057
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-3139
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1601 23RD AVE SOUTH
Practice Address - Street 2:SUITE 3057
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-3139
Practice Address - Country:US
Practice Address - Phone:615-327-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN513282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry