Individual
STEVEN KELLY GRANGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
465 PONDEROSA DR, THOMASTON, GA 30286-1356
(470) 296-5608
Mailing address
465 PONDEROSA DR, THOMASTON, GA 30286
(470) 296-5608
Taxonomy
Speciality
Code
Description
License number
State
101200000X
Drama Therapist
—
—
102X00000X
Poetry Therapist
Primary
—
—
2251C2600X
Cardiopulmonary Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
705007343
—
GA
Enumeration date
12/25/2023
Last updated
12/25/2023
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