Provider Demographics
NPI:1841315595
Name:MACDONALD, GRANT PAUL (OD)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:PAUL
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:481 GRANT ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-3154
Mailing Address - Country:US
Mailing Address - Phone:404-932-7163
Mailing Address - Fax:770-254-9997
Practice Address - Street 1:1065 SULLIVAN RD
Practice Address - Street 2:SUITE C
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-5545
Practice Address - Country:US
Practice Address - Phone:770-254-9997
Practice Address - Fax:770-254-0134
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA1560152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA41ZCGJXMedicare Oscar/Certification