Provider Demographics
NPI:1598761892
Name:GRANT, TERRY ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:ALAN
Last Name:GRANT
Suffix:
Gender:M
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 K
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27533-9710
Mailing Address - Country:US
Mailing Address - Phone:919-731-6060
Mailing Address - Fax:919-731-6534
Practice Address - Street 1:2700 WAYNE MEMORIAL DR
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9494
Practice Address - Country:US
Practice Address - Phone:919-731-6060
Practice Address - Fax:919-731-6534
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39603207P00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
36802OtherBLUE CROSS BLUE SHIELD
NC8936802Medicaid
36802OtherBLUE CROSS BLUE SHIELD
2154488EMedicare PIN
2326720Medicare UPIN
E59346Medicare UPIN