Provider Demographics
NPI:1598445496
Name:SHULER, GRANT N
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:N
Last Name:SHULER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GOVERNORS TRCE # 100
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4856
Mailing Address - Country:US
Mailing Address - Phone:770-268-2798
Mailing Address - Fax:
Practice Address - Street 1:100 GOVERNORS TRCE # 100
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4856
Practice Address - Country:US
Practice Address - Phone:770-268-2798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-22-219010106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician