Provider Demographics
NPI:1891927893
Name:GRANT, AUSTIN MITCHELL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:MITCHELL
Last Name:GRANT
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3210 SYDENHAM ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4844
Mailing Address - Country:US
Mailing Address - Phone:757-647-1897
Mailing Address - Fax:
Practice Address - Street 1:1001 SAM PERRY BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4453
Practice Address - Country:US
Practice Address - Phone:540-741-1167
Practice Address - Fax:540-741-1164
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2021-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110003070363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant