Individual
EDWARD KEITH GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
004120
GA
363A00000X
Physician Assistant
4120
GA
363AS0400X
Surgical Physician Assistant
Primary
4120
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
542228866E
—
GA
01
—
P00758778
MEDICARE RAILROAD
GA
Enumeration date
06/21/2005
Last updated
01/26/2026
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