Individual
GRANT GARNER DAVIDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1 MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2011
Mailing address
4766 EAGLE PATH, WINSTON SALEM, NC 27127-6816
(803) 486-1066
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1161876
NC
Other
Enumeration date
06/09/2019
Last updated
06/09/2019
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