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Individual

CARLY COOK GRANATA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
10236 LAKE ARBOR WAY, MITCHELLVILLE, MD 20721-3113
(240) 436-2840
Mailing address
10236 LAKE ARBOR WAY, MITCHELLVILLE, MD 20721-3113
(404) 362-8402

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110007055
VA
363A00000X
Physician Assistant
C0008389
MD

Other

Enumeration date
01/11/2019
Last updated
06/10/2022
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