Provider Demographics
NPI:1710985122
Name:GRANT, MARION WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MARION
Middle Name:WILLIAM
Last Name:GRANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7627
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36670-0627
Mailing Address - Country:US
Mailing Address - Phone:251-633-7211
Mailing Address - Fax:251-633-7367
Practice Address - Street 1:403A HIGHWAY 43 S
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-2812
Practice Address - Country:US
Practice Address - Phone:251-679-9300
Practice Address - Fax:251-679-9300
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-09
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000205752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51526624OtherB/C
H08764Medicare UPIN