Provider Demographics
NPI:1659416691
Name:BRYAN-GRANT, SHARON M (NP)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:M
Last Name:BRYAN-GRANT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:M
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,CPNP
Mailing Address - Street 1:236 ARROWHEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1106
Mailing Address - Country:US
Mailing Address - Phone:770-478-9240
Mailing Address - Fax:770-478-0318
Practice Address - Street 1:236 ARROWHEAD BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1106
Practice Address - Country:US
Practice Address - Phone:770-478-9240
Practice Address - Fax:770-478-0318
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN158290363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA203042010CMedicaid
GA203042010BMedicaid