Provider Demographics
NPI:1750192977
Name:GRAN-GC SERVIVES
Entity type:Organization
Organization Name:GRAN-GC SERVIVES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-493-7533
Mailing Address - Street 1:2600 HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:NESBIT
Mailing Address - State:MS
Mailing Address - Zip Code:38651-9607
Mailing Address - Country:US
Mailing Address - Phone:901-493-7533
Mailing Address - Fax:
Practice Address - Street 1:2600 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:NESBIT
Practice Address - State:MS
Practice Address - Zip Code:38651-9607
Practice Address - Country:US
Practice Address - Phone:901-493-7533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Multi-Specialty