Provider Demographics
NPI:1417366543
Name:GRANT, ANGELA JOY (APRN-BC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JOY
Last Name:GRANT
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:JOY
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 935722
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-5722
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:1655 BERNARDIN AVE STE 220
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2044
Practice Address - Country:US
Practice Address - Phone:803-409-7170
Practice Address - Fax:803-409-7175
Is Sole Proprietor?:No
Enumeration Date:2014-08-02
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18985363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3045Medicaid