# GRANT FAMILY MEDICINE, LLC

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

## Provider details

- **NPI number:** 1316948649
- **Authorized official:** HILDA BERNICE CRAZE M.D. (OWNER)
- **Authorized official phone:** (256) 728-8600

## Contact information

- **Practice address:** 4500 MAIN ST, GRANT, AL 35747-8303
- **Practice address phone:** (256) 728-8600
- **Practice address fax:** (256) 728-8602
- **Mailing address:** 4500 MAIN ST, GRANT, AL 35747-8303
- **Mailing address phone:** (256) 728-8600
- **Mailing address fax:** (256) 728-8602

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 12795 | AL | Yes |

## Other

- **Enumeration date:** 08/09/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 404999 | AETNA | AL |
| 01 | — | 51000192 | BLUE CROSS BLUE SHIELD | AL |