Basic Information
| Provider Information | |||||||||
| NPI: | 1902081078 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PATRICIA R. GRANT, MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 219 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294402403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435455927 | ||||||||
| FaxNumber: | 8435204780 | ||||||||
| Practice Location | |||||||||
| Address1: | 219 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294402403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435455927 | ||||||||
| FaxNumber: | 8435204780 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2008 | ||||||||
| LastUpdateDate: | 10/06/2010 | ||||||||
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| AuthorizedOfficialLastName: | GRANT | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8435455927 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 30449 | SC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 304496 | 05 | SC | MEDICAID |