Provider Demographics
NPI:1508841156
Name:GRANT, PATRICIA R (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:R
Last Name:GRANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2130
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-2130
Mailing Address - Country:US
Mailing Address - Phone:843-894-0978
Mailing Address - Fax:843-894-1106
Practice Address - Street 1:313B COMMERCE DR
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-6052
Practice Address - Country:US
Practice Address - Phone:843-894-0978
Practice Address - Fax:843-894-1106
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93086207LP2900X
TN41281207LP2900X
GA052941207LP2900X
SC30449207LP2900X
NC2006-01969207LP2900X
SCTL30449207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC304496Medicaid
SCAA2508Medicare UPIN
SCI48519Medicare UPIN
SC304496Medicaid