Individual
ALISA DIANE GRANT I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
230 VENTURE CIR, NASHVILLE, TN 37228-1604
(615) 460-4100
(615) 460-4100
Mailing address
2333 ROSA L PARKS BLVD APT 5092333, NASHVILLE, TN 37228-1225
(615) 887-8840
(615) 887-8840
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
000-1005
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZEB908011644
BLUE CROSS BLUE SHEILD
TN
Enumeration date
04/10/2020
Last updated
04/10/2020
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