# THE GRANT CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235466996
- **Authorized official:** MARC GRANT DO (PRESIDENT)
- **Authorized official phone:** (602) 327-0184

## Contact information

- **Practice address:** 14640 N TATUM BLVD STE 7, PHOENIX, AZ 85032-4824
- **Practice address phone:** (602) 327-0184
- **Practice address fax:** (602) 358-8063
- **Mailing address:** PO BOX 45379, PHOENIX, AZ 85064-5379
- **Mailing address phone:** (602) 327-0184
- **Mailing address fax:** (602) 358-8063

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LA0401X | Addiction Medicine (Anesthesiology) Physician | 1609 | AZ | Yes |

## Other

- **Enumeration date:** 11/17/2009
- **Last updated:** 11/17/2009