Provider Demographics
NPI:1710015672
Name:GRANICH, STEVEN (DSW)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:GRANICH
Suffix:
Gender:M
Credentials:DSW
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 5328
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-0328
Mailing Address - Country:US
Mailing Address - Phone:706-324-7241
Mailing Address - Fax:706-324-0027
Practice Address - Street 1:9067 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:GA
Practice Address - Zip Code:31820-3411
Practice Address - Country:US
Practice Address - Phone:706-324-7241
Practice Address - Fax:706-324-0027
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical