Provider Demographics
NPI:1659921625
Name:GRANT, CHARMAINE P (NP)
Entity Type:Individual
Prefix:MISS
First Name:CHARMAINE
Middle Name:P
Last Name:GRANT
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:1835 SAVOY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1071
Mailing Address - Country:US
Mailing Address - Phone:678-288-9555
Mailing Address - Fax:678-288-9556
Practice Address - Street 1:1100 JOHNSON FERRY RD STE 600
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1739
Practice Address - Country:US
Practice Address - Phone:404-256-4777
Practice Address - Fax:404-256-5515
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN251649363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner