Individual
JARED MCKINLEY GRANTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1108 ROSS CLARK CIR, DOTHAN, AL 36301-3022
(334) 793-8087
(334) 793-8191
Mailing address
PO BOX 1928, DOTHAN, AL 36302-1928
(334) 793-8087
(334) 793-8191
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1-137611
AL
Other
Enumeration date
12/11/2012
Last updated
12/11/2012
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