Provider Demographics
NPI:1790736262
Name:SCARBOROUGH, GRANT J (MD)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:J
Last Name:SCARBOROUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-7408
Mailing Address - Country:US
Mailing Address - Phone:706-507-9209
Mailing Address - Fax:706-507-9249
Practice Address - Street 1:3702 2ND AVE.
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904
Practice Address - Country:US
Practice Address - Phone:706-507-9209
Practice Address - Fax:706-507-9249
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA58922208000000X, 207R00000X
GAPSY004241103T00000X
GADN1226551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3338977Medicare PIN
TNI53446Medicare UPIN