Grant, Edward Keith

Grant, Edward Keith is an individual health care provider with primary practice located at 3708 Northside Dr , Macon GA 31210-2404. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Grant, Edward Keith can be contacted via phone (478) 745-4206.

Contact Information

Primary practice address
3708 Northside Dr Macon GA 31210-2404
Phone: (478) 745-4206
Fax: (478) 254-5463
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 004120 Georgia

Profile Details

NPI number 1245236744
LBN Legal business name Grant, Edward Keith
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 21st, 2005
Last updated Jun 1st, 2011 - about 14 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 1245236744 NPPES
Georgia MEDICAID 542228866E
Georgia Other P00758778

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