Individual
ALYSSA GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3150 PLATEAU DR LOT 303, COLUMBUS, GA 31903-5400
(706) 322-3773
Mailing address
2101 HAMILTON RD, COLUMBUS, GA 31904-8834
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
26-4503737
—
GA
Enumeration date
12/19/2022
Last updated
12/19/2022
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