Provider Demographics
NPI:1710012943
Name:GRANT, ALIM JAMAL SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALIM
Middle Name:JAMAL
Last Name:GRANT
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3280 OLD ALABAMA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8544
Mailing Address - Country:US
Mailing Address - Phone:404-437-7331
Mailing Address - Fax:404-437-7599
Practice Address - Street 1:3280 OLD ALABAMA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-8544
Practice Address - Country:US
Practice Address - Phone:404-437-7331
Practice Address - Fax:404-437-7599
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0127431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1487913OtherUNITED CONCORDIA INSURANC
GA904873006BMedicaid