Land, Grant Thomas
Land, Grant Thomas is an individual health care provider with primary practice located at 1445 Old Mcdonough Hwy Se, Suite E , Conyers GA 30094-7788. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Physician Assistants & Advanced Practice Nursing Providers / Medical. Physician Assistants & Advanced Practice Nursing Providers / Medical is his primary health care specialty. Land, Grant Thomas can be contacted via phone (770) 922-9222.Contact Information
Primary practice address
1445 Old Mcdonough Hwy Se, Suite E
Conyers GA 30094-7788
Phone: (770) 922-9222
Fax: (770) 504-6318
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 004108 | Georgia |
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 004108 | Georgia |
Profile Details
| NPI number | 1508816570 |
|---|---|
| LBN Legal business name | Land, Grant Thomas |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 11th, 2006 |
| Last updated | May 23rd, 2024 - about 4 months 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1508816570 | NPPES |
| Georgia | MEDICAID | 003200095A | |
| Georgia | Other | 004108 |
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