Provider Demographics
NPI:1861668295
Name:GRANT, DONNA R (AUD,CCC-A)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:R
Last Name:GRANT
Suffix:
Gender:F
Credentials:AUD,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 POINTE NORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-1514
Mailing Address - Country:US
Mailing Address - Phone:229-435-7161
Mailing Address - Fax:229-438-8588
Practice Address - Street 1:605 POINTE NORTH BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31721-1514
Practice Address - Country:US
Practice Address - Phone:229-435-7161
Practice Address - Fax:229-438-8588
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003789231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAUD003789OtherSTATE LICENSE NUMBER