Individual
CRYSTAL DALE GRANTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
210 BAY AVE, RICHTON, MS 39476-9665
(601) 788-9222
(601) 788-6318
Mailing address
178 HIGHWAY 24 E, CENTREVILLE, MS 39631-4171
(601) 890-0500
(601) 645-5873
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
902689
MS
Other
Enumeration date
06/19/2018
Last updated
05/07/2026
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