Individual
GRANT BREELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
815 S PINE ST, VIVIAN, LA 71082-3353
(318) 375-3235
(706) 596-6704
Mailing address
PO BOX 3488 DEPT 05-048, TUPELO, MS 38803-3488
(866) 264-3435
(706) 596-6704
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
207R00000X
Internal Medicine Physician
U6923
TX
2085R0202X
Diagnostic Radiology Physician
Primary
U6923
TX
Other
Enumeration date
04/01/2020
Last updated
05/14/2025
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