# GRANT CLINIC

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

## Provider details

- **NPI number:** 1669504585
- **Authorized official:** OLYMPIA TUCKER (OFFICE MANAGER)
- **Authorized official phone:** (256) 728-4219

## Contact information

- **Practice address:** 91 2ND AVE, GRANT, AL 35747
- **Practice address phone:** (256) 728-4219
- **Practice address fax:** (256) 728-7793
- **Mailing address:** PO BOX 429, GRANT, AL 35747-0429
- **Mailing address phone:** (256) 728-4219
- **Mailing address fax:** (256) 728-7793

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 3517 | AL | Yes |

## Other

- **Enumeration date:** 03/09/2007
- **Last updated:** 08/04/2009