Granger, Tommie Mack

Granger, Tommie Mack is an sole proprietor health care provider with primary practice located at 211 4Th St Box 30163, Alexandria LA 71301-8421. He recently has only one registered license in Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery), which is considered as his primary health care specialty. Granger, Tommie Mack can be contacted via phone (318) 767-5878.

Contact Information

Primary practice address
211 4Th St Box 30163 Alexandria LA 71301-8421
Phone: (318) 767-5878
Fax: (318) 767-5887
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) 208G00000X 10146R Louisiana

Profile Details

NPI number 1124018866
LBN Legal business name Granger, Tommie Mack
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 25th, 2005
Last updated Dec 2nd, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124018866 NPPES
Northern Mariana Islands Other 126445 MISSISSIPPI MEDICAID
Northern Mariana Islands MEDICAID 1982067 MISSISSIPPI MEDICAID

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