Provider Demographics
NPI:1356386346
Name:MAJOR, GRANT R (MD)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:R
Last Name:MAJOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CLARK-HOLDER CLINIC, P.A.
Mailing Address - Street 2:303 SMITH STREET
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240
Mailing Address - Country:US
Mailing Address - Phone:706-882-8831
Mailing Address - Fax:706-812-4091
Practice Address - Street 1:CLARK-HOLDER CLINIC, P.A.
Practice Address - Street 2:303 SMITH STREET
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240
Practice Address - Country:US
Practice Address - Phone:706-882-8831
Practice Address - Fax:706-812-4091
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA31790208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA02BDBCFMedicare ID - Type Unspecified
A99035Medicare UPIN