Individual
MICAH ALEXANDER GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
3549 BLUECUTT RD, COLUMBUS, MS 39705-1324
(662) 570-4174
(662) 570-4108
Mailing address
3549 BLUECUTT RD, COLUMBUS, MS 39705-1324
(662) 570-4174
(662) 570-4108
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
R874310
MS
363LF0000X
Family Nurse Practitioner
Primary
F0115273
MS
Other
Enumeration date
08/20/2014
Last updated
11/09/2021
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