Organization
GRANT FAMILY MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HILDA BERNICE CRAZE M.D. (OWNER)
(256) 728-8600
Entity
Organization
Contact information
Practice address
4500 MAIN ST, GRANT, AL 35747-8303
(256) 728-8600
(256) 728-8602
Mailing address
4500 MAIN ST, GRANT, AL 35747-8303
(256) 728-8600
(256) 728-8602
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
12795
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
404999
AETNA
AL
01
—
51000192
BLUE CROSS BLUE SHIELD
AL
Enumeration date
08/09/2005
Last updated
08/22/2020
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