Provider Demographics
NPI:1639669922
Name:YARBROUGH, GRANT LAWSON
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:LAWSON
Last Name:YARBROUGH
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 1:420 JACK YEATTS RD
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-8992
Mailing Address - Country:US
Mailing Address - Phone:336-213-5253
Mailing Address - Fax:
Practice Address - Street 1:420 JACK YEATTS RD
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-8992
Practice Address - Country:US
Practice Address - Phone:336-213-5253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-13
Last Update Date:2018-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer