Individual
DR. TOMMIE MACK GRANGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
211 4TH ST, BOX 30163, ALEXANDRIA, LA 71301-8421
(318) 767-5878
(318) 767-5887
Mailing address
211 4TH ST, BOX 30163, ALEXANDRIA, LA 71301-8421
(318) 767-5878
(318) 767-5887
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
10146R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
126445
MISSISSIPPI MEDICAID
MP
05
—
1982067
—
LA
Enumeration date
10/25/2005
Last updated
12/02/2013
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