Individual
DR. DANIEL HICKY GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED. D.
Contact information
Practice address
1061 HARMON AVE STE 1D03, FORT STEWART, GA 31314-5641
(912) 435-6633
Mailing address
1061 HARMON AVE STE 1D03, FORT STEWART, GA 31314-5641
(912) 435-6633
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY000859
GA
103T00000X
Psychologist
PSY000859
GA
103TF0200X
Forensic Psychologist
PSY000859
GA
Other
Enumeration date
08/04/2011
Last updated
11/28/2011
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